title: Managed care's clinical and economic impact on patients with type II diabetes in France: a controlled population-based study.
abstract: OBJECTIVE
  The purpose of this paper is to assess the impact of five type II diabetes managed care programmes (MCPs) in clinical and economic terms at the community level in which these programmes function in the Provence-Alpes-Côte d'Azur region of France.
  
  
  METHODS
  A prospective, controlled, before-and-after study (2001-2004) compared diabetic patients who lived in departments (localities) with (the experimental group) and without a MCP (the control group). Quality of care was estimated by the conformity of health care professionals' practices when following-up type II diabetes. Costs are compared from a health service perspective.
  
  
  RESULTS
  The study finds that of 626 patients enrolled, 529 lived in departments with an MCP and 97 patients in departments without. Type II diabetes follow-up globally improved between the two study periods (2001 and 2004), but the study did not show significant differences between the two groups, except for the proportion of creatinine and ophthalmologic examinations, which were higher for the control group. The study did not find significant differences in the increase of costs between the two groups from 2001 to 2004.
  
  
  CONCLUSIONS
  This type of study could constitute a methodological model to assess the MCPs population impact.
  
  
  CONCLUSIONS
  MCPs probably did not reach a critical size in terms of patient recruitment and healthcare professional adhesion to have a significant impact at a population level.
  
  
  CONCLUSIONS
  The study highlights a number of points to consider for future MCPs in France.
authors.affiliation: Unité d'Evaluation Médicale, CHU Grenoble, Union Régionale des Caisses d'Assurance Maladie et Agence Régionale d'Hospitalisation de la Région Provence Alpes Côte d'Azur, Grenoble, France. laurentb_perso@hotmail.com
authors.forename: Laurent
authors.initials: L
authors.lastname: Boyer
authors.forename: Patrice
authors.initials: P
authors.lastname: François
authors.forename: Magali
authors.initials: M
authors.lastname: Fourny
authors.forename: Céline
authors.initials: C
authors.lastname: Ohrond
authors.forename: Charles
authors.initials: C
authors.lastname: Chanut
authors.forename: José
authors.initials: J
authors.lastname: Labarère
authors.forename: Pascal
authors.initials: P
authors.lastname: Auquier
mesh_terms: D000368:Aged; D001786:Blood Glucose; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000191:economics* / Q000628:therapy*; D019468:Disease Management; D005260:Female; D005602:France; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D011446:Prospective Studies; D011787:Quality of Health Care / Q000191:economics / Q000458:organization & administration*
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents