Miksch Antje, Trieschmann Johanna, Ose Dominik, Rölz Andreas, Heiderhoff Marc, Szecsenyi Joachim
Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg.
Z Evid Fortbild Qual Gesundhwes. 2011;105(6):427-33. doi: 10.1016/j.zefq.2010.06.026. Epub 2010 Jul 21.
Effective implementation of disease management programmes (DMPs) in primary care practices often requires changes in practice workflows and responsibilities and acceptance by the parties involved. Within the ELSID study (evaluation study of the DMP diabetes mellitus type 2) the physicians' attitudes toward DMPs were obtained and an optimised implementation of DMPs was developed by conducting a quality management cycle with primary care practice teams. The aim was to investigate which practice workflows will have to be changed and what kind of barriers to implement these changes are perceived.
In 78 primary care practices of the two German federal states of Rheinland-Pfalz and Sachsen-Anhalt a quality management cycle was conducted using a structured analysis of the current state of DMP workflows and the need for improvement identified. Subsequently, an optimised workflow was developed and targets were agreed upon. After 6 months, the study team called to inquire about the current state of implementation and, if appropriate, actual barriers to change.
After 6 months, 71 practices had been interviewed by phone. 64 of them (90.1%) had agreed on at least one target (e.g., to purchase new instrumentation, to regularly discuss feedback reports, to set up a patient registry). On average three targets had been formulated, and 2 out of 3 had been implemented in the meantime. In most cases lack of time was given as the reason for non-implementation.
The majority of surveyed practices perceived some need for improvement. But sufficient resources (time, staff and money) are required to ensure efficient implementation of DMPs in primary care practices and their integration with routine processes. A redefinition of responsibilities for DMPs will strengthen the role of medical assistants and promote high-quality implementation of these programmes.
在初级医疗实践中有效实施疾病管理项目（DMP）通常需要改变实践工作流程和职责，并得到相关各方的认可。在ELSID研究（2型糖尿病DMP评估研究）中，了解了医生对DMP的态度，并通过与初级医疗实践团队开展质量管理循环，制定了DMP的优化实施方案。目的是调查哪些实践工作流程需要改变，以及实施这些改变会遇到何种障碍。
在德国莱茵兰-普法尔茨州和萨克森-安哈尔特州的78家初级医疗实践机构中，对DMP工作流程的现状进行了结构化分析，确定了改进需求，进而开展质量管理循环。随后，制定了优化工作流程并商定了目标。6个月后，研究团队致电询问实施现状以及（如适用）实际的变革障碍。
6个月后，通过电话对71家实践机构进行了访谈。其中64家（90.1%）至少就一个目标达成了一致（如购买新设备、定期讨论反馈报告、建立患者登记册）。平均制定了三个目标，其中三分之二已在此期间实施。在大多数情况下，未实施的原因是时间不足。
大多数接受调查的实践机构认为存在一些改进需求。但需要足够的资源（时间、人员和资金）来确保在初级医疗实践中有效实施DMP，并使其与常规流程相结合。重新定义DMP的职责将加强医疗助理的作用，并促进这些项目的高质量实施。
