Attitudes to and experience of disease management programs in primary care—an exploratory survey of general practitioners in Germany

Abstract

Summary Background Disease management programs (DMPs) were set up in Germany in 2003 to improve outpatient care of chronically ill patients. The present study looks at the attitudes and experiences of general practitioners (GPs) in relation to DMPs, how they rate them almost 20 years after their introduction and where they see a need for improvement. Methods A total of 1504 GPs in the Federal States of Rhineland Palatinate, Saarland and Hesse were surveyed between December 2019 and March 2020 using a written questionnaire. Results In total, 58% of respondents rate DMPs positively and regard them as making a useful contribution to primary care. The guarantee of regular, structured patient care and greater compliance are regarded as particularly positive aspects. It was also established that diagnostic and therapeutic knowledge was expanded through participation in DMPs. 57% essentially follow the DMP recommendations for (drug) treatment. Despite positive experiences of DMPs in patient care, the GPs surveyed mention various challenges (documentation requirements, frequent changes to the programmes, inflexibility). Univariant linear regression analysis revealed factors influencing the satisfaction with DMPs, such as improvement of compliance and clearly defined procedures in medical care. Conclusion Most of the GPs surveyed consider the combination of continuous patient care and evidence-based diagnosis and treatment to be a great advantage. To better adapt DMPs to the conditions of primary care, it makes sense to simplify the documentation requirements, to regulate cooperation with other healthcare levels more clearly and to give GPs more decision-making flexibility. Increased inclusion of GP experience in the process of developing and refining DMPs can be helpful.

Primary care involvement in clinical research – prerequisites, motivators, and barriers: results from a study series

“…Urban physicians in the quantitative survey sample [ 30 ] identified clear benefits from clinical studies and cRCTs, but their rural counterparts took a more cautious stance. This tallies with the general research findings that GPs in rural areas perceive lower added value in evidence-based structures and instruments [ 39 , 40 ]. Likewise, most of the 24% of respondents having already taken part in cRCTs were located in urban areas with a greater variety of care services, which is often a prerequisite in effective clinical research [ 7 , 9 ].…”

“…The results from the survey may be seen as confirmation of increased willingness amongst GPs to participate in empirical, evidence-oriented studies with the aim of optimising healthcare [ 15 ]. Especially younger GPs in urban catchment areas are increasingly basing their work on standardised, evidence-based interventions [ 39 , 40 ]. Even so, a substantial proportion of general medical practices are fundamentally unwilling or remain reluctant regarding these research projects [ 1 , 7 – 9 ].…”

“…GPs expressed a desire for a manageable and predictable additional workload such as in the complexity of the intervention to be used and in administrative and documentation tasks without excessively interfering with established practice routines [ 36 , 39 , 40 , 49 ]. GPs also wished for more individual flexibility in action and decision-making extending beyond participation in research activities to involvement in evidence-based structures and instruments such as disease management programmes and guidelines.…”

Exploring healthcare provider and patient perspectives on current outpatient care of venous leg ulcers and potential interventions to improve their treatment: a mixed methods study in the ulcus cruris care project

“…Participants in this study had a positive view on the UCC concept and referenced prior experiences with disease management programs to support this view. Such programs are well established in German primary care and are seen as contribution to structured patient care, therapy adherence, and expanded diagnostic and therapeutic knowledge [ 40 , 41 ]. However, there were concerns mentioned particularly with regards to the amount of documentation required in a structured VLU care program and to a potentially reduced flexibility for tailoring treatment individually to wounds and patients.…”

Exploring regional and sociodemographic disparities associated with unenrollment for the disease management program for type 2 Diabetes Mellitus using Bayesian spatial modelling

“…Another limitation is that we could only focus on individual insurant and area-level characteristics but could not include information on the attitude towards DMPs of the general physicians in the area. It is possible that there are differences in the attitudes of the physicians regarding the DMP T2DM, influencing the enrollment rates in the respective regions [41].…”