title: [General practitioners' opinion and attitude towards DMPs and the change in practice routines to implement the DMP "diabetes mellitus type 2"].
abstract: BACKGROUND
  Effective implementation of disease management programmes (DMPs) in primary care practices often requires changes in practice workflows and responsibilities and acceptance by the parties involved. Within the ELSID study (evaluation study of the DMP diabetes mellitus type 2) the physicians' attitudes toward DMPs were obtained and an optimised implementation of DMPs was developed by conducting a quality management cycle with primary care practice teams. The aim was to investigate which practice workflows will have to be changed and what kind of barriers to implement these changes are perceived.
  
  
  METHODS
  In 78 primary care practices of the two German federal states of Rheinland-Pfalz and Sachsen-Anhalt a quality management cycle was conducted using a structured analysis of the current state of DMP workflows and the need for improvement identified. Subsequently, an optimised workflow was developed and targets were agreed upon. After 6 months, the study team called to inquire about the current state of implementation and, if appropriate, actual barriers to change.
  
  
  RESULTS
  After 6 months, 71 practices had been interviewed by phone. 64 of them (90.1%) had agreed on at least one target (e.g., to purchase new instrumentation, to regularly discuss feedback reports, to set up a patient registry). On average three targets had been formulated, and 2 out of 3 had been implemented in the meantime. In most cases lack of time was given as the reason for non-implementation.
  
  
  CONCLUSIONS
  The majority of surveyed practices perceived some need for improvement. But sufficient resources (time, staff and money) are required to ensure efficient implementation of DMPs in primary care practices and their integration with routine processes. A redefinition of responsibilities for DMPs will strengthen the role of medical assistants and promote high-quality implementation of these programmes.
authors.affiliation: Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg. antje.miksch@med.uni-heidelberg.de
authors.forename: Antje
authors.initials: A
authors.lastname: Miksch
authors.forename: Johanna
authors.initials: J
authors.lastname: Trieschmann
authors.forename: Dominik
authors.initials: D
authors.lastname: Ose
authors.forename: Andreas
authors.initials: A
authors.lastname: Rölz
authors.forename: Marc
authors.initials: M
authors.lastname: Heiderhoff
authors.forename: Joachim
authors.initials: J
authors.lastname: Szecsenyi
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003362:Cost-Benefit Analysis; D003625:Data Collection; D003924:Diabetes Mellitus, Type 2 / Q000191:economics / Q000628:therapy*; D019468:Disease Management; D005260:Female; D058006:General Practice / Q000191:economics; D005858:Germany; D006284:Health Plan Implementation / Q000191:economics / Q000458:organization & administration*; D006301:Health Services Needs and Demand / Q000191:economics / Q000458:organization & administration; D006302:Health Services Research / Q000458:organization & administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration; D017749:Total Quality Management / Q000191:economics / Q000458:organization & administration; D057188:Workflow