Health care by a DMP for diabetes mellitus type 2—results of a survey of participating insurance customers of a health insurance company in Germany

摘要

Since the late 1990s, intensive efforts have been made in Germany to enhance integration within the fragmented health care sector. Disease management programmes (DMPs) represent an attempt to improve the care for the chronically ill, which is known to be deficient in particular for diabetics. A representative telephone survey was carried out of participants in the DMP for diabetics (customers of the BARMER Health Insurance, Neubrandenburg) to investigate preferences, motives and assessments of participants (random sample, net = 124, June 2005). The interviewees were generally aged 61 years or older (77.4%), and two-thirds of them had suffered from diabetes or received treatment for more than 5 years. During the programme, the proportion consulting a specially trained diabetology physician doubled to 31%. The assessment of the quality of care improved markedly; 19% of the participants reported an improvement in their health status. The main reasons given for participating in the DMP were anticipated improvement in the quality of care and the activation of the patient role. Analyses indicate that those who reported the most benefit from the programme are the core group of the elderly chronically ill. However, as this group was particularly well informed about their own disease, attention should always be paid to the possibility of social selection processes in such health programmes. Quality studies in the past have not provided a comprehensive picture, so quality assurance studies should be carried out in order to validate surveys addressing participants in DMPs, and conversely surveys of DMP participants should be conducted to validate quality assurance findings. Surveys of health insurance customers can provide valuable information about the opinions of the patients themselves and allow the investigation of social influences. Considerable work remains necessary in Germany to develop appropriate methodologies.