Küver Claudia, Beyer Martin, Gensichen Jochen, Ludt Sabine, Schmitz Anja, Szecsenyi Joachim, Gerlach Ferdinand M
Institut für Aligemeinmedizin am Universitätsklinikum Schleswig-Holstein, Kiel.
Z Arztl Fortbild Qualitatssich. 2004 Aug;98(5):393-402.
Patient education programmes will be a mandatory part of the new legislation on disease management programmes for chronic diseases in Germany. Today, only little is known about the number, variety and effectiveness of implemented patient education programmes in Germany.
176 potential providers of patient education programmes were identified by literature search, Internet search, and interviews with health education experts. We developed a semi-structured questionnaire. Assessment of content and quality was conducted in two steps by using defined criteria of the Co-ordinating Committee, the Head Association of the statutory health insurances and the respective Medical Associations: the first step was to check whether the programme had a structured teaching concept and whether all requirements for education with respect to a given disease had been taken into account. In the second step, we used balance sheets for reviewing the strengths and weaknesses of the programmes.
49 providers handed in 95 pa tient education programmes for assess ment. Due to formal mistakes only 91 programmes could be analysed. 49 programmes failed the criteria of the first assessment step. For the remaining 42 patient education programmes balance sheets were prepared. Areas of the most frequent deficiencies included: lack of scientific evaluation of the effectiveness of the programme, lack of transparency of cost data, and quality improvement activities.
For the purpose of a nation-wide implementation of disease management programmes the existing patient education programmes in Germany need to be further improved. Single examples demonstrated that the accessible criteria of self-management are not sufficient for the evaluation of already established patient education programmes.
患者教育项目将成为德国慢性病疾病管理项目新立法的一项强制内容。目前,对于德国已实施的患者教育项目的数量、种类和效果了解甚少。
通过文献检索、互联网搜索以及与健康教育专家访谈,确定了176个潜在的患者教育项目提供者。我们编制了一份半结构化问卷。根据协调委员会、法定医疗保险总协会以及各医学协会规定的标准,分两步对内容和质量进行评估:第一步检查项目是否有结构化的教学理念,以及是否考虑到了针对某一特定疾病的所有教育要求。第二步,我们使用资产负债表来审视项目的优势和劣势。
49个提供者提交了95个患者教育项目以供评估。由于形式上的错误,仅有91个项目能够被分析。49个项目未通过第一步评估的标准。为其余42个患者教育项目编制了资产负债表。最常见的不足之处包括:缺乏对项目效果的科学评估、成本数据缺乏透明度以及质量改进活动。
为了在全国范围内实施疾病管理项目,德国现有的患者教育项目需要进一步改进。个别实例表明,现有的自我管理评估标准不足以评估已有的患者教育项目。