German diabetes disease management programs are appropriate to restructure care according to the Chronic Care Model. An evaluation with the Patient Assessment of Chronic Illness Care (PACIC-5A) instrument

Objective: With the introduction of diabetes disease management programs (DMP) in Germany there is a necessity to evaluate whether patients receive care which is congruent to the chronic care model (CCM) and evidence-based behavioural counselling. We examined differences as perceived and experienced by patients with type 2 between those enrolled in a DMP compared to patients receiving usual care in two federal states of Germany. Research Design And Methods: A random, heterogeneous sample of 3,546 patients (59.3% female) received a mailed questionnaire from their regional health fund including the German version of the Patient Asessment of Chonic Illness Care (PACIC) instrument, including additional items for behavioural advice (5A). Two weeks later a general reminder was sent out. Results: 1,532 questionnaires were returned (response rate 42.2%), valid data could be obtained for 1,399 patients. Mean age of responders was 70.3 years of which 53.6% were female. Overall, patients enrolled in a DMP scored significantly higher (3.21 of a possible 5) than patients not enrolled in a DMP (2.86; p< 0.001). Significant differences in the same direction were found on all five subscales of the PACIC. For the 5A scales similar differences were found for all 5 subscales plus the sum score (p<0.001; mean for DMP=3.08, mean for non-DMP=2.78). Conclusions: DMPs as currently established in primary care in Germany may impact provided care significantly. The changes in daily practice which have been induced by the DMPs are recognized by patients as care that is more structured and that reflects the core elements of the CCM and evidence-based counselling to a larger extent as usual care. Disease management programs and PACIC-5A 3 mproving the quality of care for patients with type 2 diabetes and other chronic conditions is an important aim of health policy and providers in many countries throughout the world. In countries like the US, disease management programs (DMP) – defined as structured, multifaceted, systematic approaches to provide better care (1) have been introduced by a vast number of`playersánd providers with different approaches for more than twenty years (2), showing small to modest results. In Germany with its statutory health insurance system, insuring approximately 90% of the population, disease management programs were introduced nationwide in 2003 on the basis of a new legislation which aimed to improve the quality of care and to foster competition between health insurances (3,4). In contrast to the US the core content of a DMP in …