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Disease management programmes for patients with coronary heart disease--An empirical study of German programmes

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  • Gapp, Oliver
  • Schweikert, Bernd
  • Meisinger, Christa
  • Holle, Rolf

Abstract

Objective To evaluate healthcare and outcomes of disease management programmes (DMPs) for patients with coronary heart disease (CHD) in primary care, and to assess selection of enrolment for these programmes.Methods A cross-sectional survey of 2330 statutorily insured patients with a history of acute myocardial infarction (AMI) was performed in 2006 by the population-based KORA Myocardial Infarction Register from the region of Augsburg, Germany. Patients enrolled in DMP-CHDs receive evidence-based care, with patients not enrolled receiving standard care. To control for selection bias, a propensity score approach was used.Results Main factors influencing DMP participation were age (OR 0.98, 95% CI 0.96-0.99), diabetes (OR 1.56, CI 1.25-1.95) and time since last heart attack (OR 0.98, CI 0.95-0.99). Significantly more patients enrolled in DMP-CHDs stated that they received medical counselling for smoking (OR 3.77, CI 1.07-13.34), nutrition (OR 2.15, 1.69-2.74) and for physical activity (OR 2.58, 1.99-3.35). Furthermore, prescription of statins (OR 1.58, CI 1.24-2.00), antiplatelets (OR 1.96, CI 1.43-2.69) and beta-blockers (not significant) were higher in the DMP group. With respect to outcomes, we did not see relevant differences in quality of life and body mass index, and only a minor reduction in smoking.Conclusions Enrolment into DMPs for CHD exhibits systematic selection effects. Participants tend to experience - at least on a short to medium term and for AMI patients - better quality of healthcare services. However, since DMP-CHDs were initiated only 2 years ago, we were unable to identify significant improvements in health outcomes. Only the reduction in smoking provides a first indication of better quality outcomes following DMP-CHD. Thus, policy-makers must provide appropriate incentives to sickness funds and physicians in order to ensure initiation and continuation of high quality DMPs.

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  • Gapp, Oliver & Schweikert, Bernd & Meisinger, Christa & Holle, Rolf, 2008. "Disease management programmes for patients with coronary heart disease--An empirical study of German programmes," Health Policy, Elsevier, vol. 88(2-3), pages 176-185, December.
    • Handle: RePEc:eee:hepoli:v:88:y:2008:i:2-3:p:176-185
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    1. Gre[ss], Stefan & Focke, Axel & Hessel, Franz & Wasem, Jurgen, 2006. "Financial incentives for disease management programmes and integrated care in German social health insurance," Health Policy, Elsevier, vol. 78(2-3), pages 295-305, October.
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    1. Röttger, Julia & Blümel, Miriam & Köppen, Julia & Busse, Reinhard, 2016. "Forgone care among chronically ill patients in Germany—Results from a cross-sectional survey with 15,565 individuals," Health Policy, Elsevier, vol. 120(2), pages 170-178.
    2. Florian Kirsch & Christian Becker & Anja Schramm & Werner Maier & Reiner Leidl, 2020. "Patients with coronary artery disease after acute myocardial infarction: effects of continuous enrollment in a structured Disease Management Program on adherence to guideline-recommended medication, h," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(4), pages 607-619, June.
    3. Becker, Christian & Holle, Rolf & Stollenwerk, Björn, 2015. "The excess health care costs of KardioPro, an integrated care program for coronary heart disease prevention," Health Policy, Elsevier, vol. 119(6), pages 778-786.
    4. Röttger, Julia & Blümel, Miriam & Linder, Roland & Busse, Reinhard, 2017. "Health system responsiveness and chronic disease care – What is the role of disease management programs? An analysis based on cross-sectional survey and administrative claims data," Social Science & Medicine, Elsevier, vol. 185(C), pages 54-62.
    5. Nickel, Stefan & Thiedemann, Birgit & von dem Knesebeck, Olaf, 2010. "The effects of integrated inpatient health care on patient satisfaction and health-related quality of life: Results of a survey among heart disease patients in Germany," Health Policy, Elsevier, vol. 98(2-3), pages 156-163, December.

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