Wangler Julian, Jansky Michael
Centre for General and Geriatric Medicine, University Medical Centre Mainz, Am Pulverturm 13, 55131, Mainz, Germany.
Wien Med Wochenschr. 2021 Oct;171(13-14):310-320. doi: 10.1007/s10354-021-00867-1. Epub 2021 Aug 2.
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.
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.
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.
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.
德国于2003年设立了疾病管理项目（DMPs），以改善慢性病患者的门诊护理。本研究探讨了全科医生（GPs）对DMPs的态度和体验，他们在引入DMPs近20年后如何评价它们，以及他们认为哪些方面需要改进。
2019年12月至2020年3月期间，使用书面问卷对莱茵兰-普法尔茨州、萨尔州和黑森州的1504名全科医生进行了调查。
总体而言，58%的受访者对DMPs给予积极评价，并认为它们对初级保健做出了有益贡献。定期、结构化的患者护理保障和更高的依从性被视为特别积极的方面。还发现，通过参与DMPs，诊断和治疗知识得到了扩展。57%的人基本上遵循DMPs关于（药物）治疗的建议。尽管DMPs在患者护理方面有积极经验，但接受调查的全科医生提到了各种挑战（文件要求、项目频繁变更、缺乏灵活性）。单变量线性回归分析揭示了影响对DMPs满意度的因素，如依从性的提高和医疗护理中明确规定的程序。
大多数接受调查的全科医生认为持续的患者护理与循证诊断和治疗相结合是一个很大的优势。为了使DMPs更好地适应初级保健的情况，简化文件要求、更明确地规范与其他医疗层面的合作以及给予全科医生更多的决策灵活性是有意义的。在DMPs的开发和完善过程中更多地纳入全科医生的经验可能会有所帮助。
