[全科医生对2型糖尿病和冠心病疾病管理项目感知效果的看法：焦点小组研究结果]

[General practitioners' perspectives on the perceived effectiveness of the disease management programs for type 2 diabetes and coronary heart disease: Results of a focus group study].

作者信息

Pilic Larisa, Molkentin Kira, Lehmann Lion, Herrmann Alina, Funke Christian, Müller Beate Sigrid, Bödecker August-Wilhelm, Redaèlli Marcus, Wilm Stefan

机构信息

Institut für Allgemeinmedizin, Universitätsklinikum Köln, Köln, Deutschland.

出版信息

Z Evid Fortbild Qual Gesundhwes. 2024 Apr;185:45-53. doi: 10.1016/j.zefq.2023.12.003. Epub 2024 Feb 28.

DOI:10.1016/j.zefq.2023.12.003

PMID:38418359

Abstract

BACKGROUND

The majority of patients in disease management programs (DMPs) for type 2 diabetes (T2DM) and coronary heart disease (CHD) in Germany are enrolled by their general practitioner (GP). The aim of this study was, in the context of upcoming DMP expansions, to elicit GPs' current experiences and opinions regarding the perceived effectiveness and acceptance of the DMPs T2DM and CHD, as well as to determine beneficial and hindering aspects of the implementation of these programs from a GP's perspective.

METHODS

In August and September 2020, 20 GPs of teaching practices of the University Hospital Cologne with experiences in DMPs were interviewed in semi-structured focus group discussions. Their expectations, attitudes and opinions regarding the DMPs T2DM and CHD were evaluated and analyzed according to the content-structuring qualitative content analysis by Kuckartz.

RESULTS

The DMP T2DM was rated as generally positive by the respondents due to the structured treatment including regular foot and eye examinations, close patient contacts and perceptions of improved health outcomes. The DMP CHD was rated more negatively by the respondents because of a high and partly unnecessary documentation workload and limited therapeutic freedom, leading to a perceived ineffectiveness for patients' health outcomes. Thus, there was a discrepancy in the perceived effectiveness of the examined DMPs, causing a lower acceptance of the DMP CHD. Therefore, some of the respondents tended to enroll fewer patients into the DMP CHD or to drop out of the DMP CHD.

DISCUSSION

In order to increase the acceptance and sustainability of DMPs some elements of the DMP CHD as well as the remuneration and the documentation need to be reconsidered. Additionally, future studies on the acceptance of DMPs should differentiate between different DMPs in order to generate valid results.

摘要

背景

在德国，2型糖尿病（T2DM）和冠心病（CHD）疾病管理项目（DMPs）中的大多数患者是由其全科医生（GP）登记入组的。在即将扩大DMPs的背景下，本研究的目的是了解全科医生目前对于DMPs中T2DM和CHD的有效性和接受度的经验和看法，并从全科医生的角度确定这些项目实施的有利和阻碍因素。

方法

2020年8月和9月，对科隆大学医院教学实践中有DMPs经验的20名全科医生进行了半结构化焦点小组讨论访谈。根据Kuckartz的内容结构化定性内容分析法，对他们对DMPs中T2DM和CHD的期望、态度和看法进行了评估和分析。

结果

受访者对DMP T2DM总体评价积极，因为其结构化治疗包括定期足部和眼部检查、与患者密切接触以及对改善健康结果的认知。受访者对DMP CHD的评价更为负面，原因是文档工作量大且部分不必要，以及治疗自由度有限，导致认为对患者健康结果无效。因此，在所检查的DMPs的有效性认知上存在差异，导致对DMP CHD的接受度较低。因此，一些受访者倾向于让较少的患者加入DMP CHD或退出DMP CHD。