Disease Management Programs for Patients With COPD in Germany: A Longitudinal Evaluation of Routinely Collected Patient Records

Abstract

INTRODUCTION:The primary aim of the disease management program (DMP) for patients with COPD is to improve health outcomes and thereby to reduce overall costs. Six years after its introduction in Germany, no consensus has yet been reached as to whether the DMP has been effective in reaching these goals. The objective of the study was an evaluation of the DMP for COPD in Bavaria using routinely collected subject medical records. METHODS: A longitudinal population-based study, comparing the total DMP population of up to 86,560 patients with a stable cohort of 17,549 subjects over a period of 5 years. The effect of subject dropout in the cohort is further estimated by means of inverse probability weighting. RESULTS: The proportion of subjects in the total population who were prescribed and received treatment with oral corticosteroids declined at a constant rate of 1.0% per year (P < .001). The proportion of subjects who were given a prescription for theophylline decreased at a constant rate of 2.0% per year (P < .001). By 2012, 15.6% of the total population and 26% of the cohort had undergone self-management education. While the proportion of smokers in the total population remained constant because of the effect of newly enrolled subjects, the proportion of smokers decreased significantly even after dropout adjustment, from 29% to 21%. The occurrence of exacerbations decreased steadily at a rate of 0.9% (total population) or 0.7% (cohort) per year. While the occurrence of emergency hospital admissions decreased in the total population, an increase was observed within the cohort. CONCLUSIONS: Summarizing all results leads to the suggestion that the German DMP for COPD has been effective in enhancing the quality of care in regard to an improved adherence to guidelines, pharmacotherapy, exacerbations, and self-management education. However, the DMP was not able to prevent an increase in emergency hospital admissions for the stable population in the cohort.

The relationship between body mass index and health-related quality of life in COPD: real-world evidence based on claims and survey data

“…However, on account of the relatively large number of observations, the findings regarding the association of BMI and HRQoL should still be valid for broader populations of COPD patients. Moreover, as DMP participation is associated with increased quality of care [ 54 ], the gap in HRQoL could be even higher in a non-DMP setting. Based on study design, a more representative approach was not possible.…”

The quality of COPD care in German general practice—A cross-sectional study

“…Although the majority of DMPs is carried out by GP practices, few of them are even exclusively managed by pulmonologists (1-2%) and other specialists (1-2%). 11 A final weakness may be the limited generalizability of our results. Not only did we analyze general practices from just one region but also these general practices were employed in the same PCN whereas usually GPs in Germany are selfemployed, many of them still in single handed practices.…”

“…Concerning COPD care quality, two published cohort evaluations of the DMP COPD revealed an improvement in adherence to guidelines 11,12 but also mentioned the problem of any DMP-evaluation, namely participation bias, with motivated patients being more likely to participate and less likely to drop out of DMPs. Knowing that only about 10% of all the patients with COPD are enrolled, 12 highlights the importance of improving the care process, irrespective of enrollment in this program.…”

Clinical governance as professional self-reflection: A cross-sectional study assessing the quality of COPD care in German general practice

“…For example, disease management programs (DMPs) were introduced in 2002 for a number of chronic conditions [7]. DMPs are based in general practice and aim at standardizing care for frequent chronic conditions, thereby improving care quality and reducing health care expenses [8,9]. This is sought to be achieved by encouraging at least half-yearly follow-up visits, GP training, patient education, standardized electronic documentation (with performance feedback and benchmarking) and other measures.…”