Structured treatment and teaching programme for type 2 diabetic patients on conventional insulin treatment: evaluation of reimbursement policy.

The aim of the study was to evaluate the practicability and efficacy of a structured treatment and teaching programme (STTP) for type 2 diabetic outpatients on conventional insulin treatment after introducing remuneration for physicians. Reimbursement policy for the STTP was introduced in the state of Brandenburg, Germany, in July 1993. Between August 1993 and February 1994, 108 physicians and their assistants participated in a postgraduate seminar, which is a prerequisite for remuneration. A standardised interview was performed with 103 physicians and their paramedical personnel. Twenty of the practices who had performed STTP were visited in order to collect data on all the patients who had participated in the programme up to September, 1994. Within the first year already 10% of the target group of physicians participated in the seminars. The seminar and the programme were very well accepted. An improvement of HbA1c levels was observed in patients who had started insulin treatment (n = 35: 9.7 +/- 1.6% of total Hb before, 8.2 +/- 1.3% of total Hb after the programme) and in those who were already being treated with insulin before the STTP (n = 125: 9.6 +/- 2.5% of total Hb before, 8.1 +/- 1.4% of total Hb after the programme). The results of the study demonstrate the efficacy and practicability of an STTP for type 2 diabetic patients on conventional insulin therapy in ambulatory health care.