Health care in and outside a DMP for type 2 diabet

Authors: Thomas Elkeles Wolf Kirschner Christian Graf Petra KellermannMühlhoff

Publish Date: 2008/12/23

Volume: 17, Issue: 3, Pages: 205-216

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Abstract

The Disease Management Programmes DMPs introduced in Germany since 2003 are intended to improve health care for the chronically ill Whether they do this is currently being investigated in various evaluation settings In order to assess possible changes in the process quality from the point of view of patients the BARMER health insurance company conducted a national postal survey in Germany in 2007 of its customers with diabetes mellitus type 2 in order to compare programme participants and nonparticipants This evaluation is a subanalysis intended to clarify whether the utilisation acceptability and perceived benefits of the programme differ as a result of educational statusA nationally representative random sample was drawn from BARMER insurance customers with type 2 diabetes aged 45–79 years Questionnaires were evaluated from 385 of the sample DMPparticipant respondents n = 2158 nonparticipant respondents n = 2182A lower educational status was related among other things with increased morbidity a poorer level of information and also a less welldeveloped “preventive attitude” to the disease The finding that 49 of participants had a higher school qualification compared with 45 of nonparticipants although significant is less pronounced than the differences found between DMP participants and nonparticipants for other values analysed A social influence could be found concerning the differences in treatment provided within the programme A multivariate analysis shows that both the participation in the programme and higher levels of education have independent positive effects on the satisfaction with health status with the effect of programme participation being strongerIt can be assumed that the clear differences established between the groups of DMP participants and nonparticipants can in no way be explained solely by the comparatively small difference related to school education Patients obviously appreciate the fact that the health personnel and the insurance company are paying increased interest to their disease and this is true to an increased degree for participants with only basic schooling Although overall this group is significantly underrepresented among the participants they reported to an increased degree that they were profiting from the programme

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