title: What part of the total care consumed by type 2 diabetes patients is directly related to diabetes? Implications for disease management programs.
abstract: BACKGROUND
  Disease management programs (DMP) aim at improving coordination and quality of care and reducing healthcare costs for specific chronic diseases. This paper investigates to what extent total healthcare utilization of type 2 diabetes patients is actually related to diabetes and its implications for diabetes management programs.
  
  
  METHODS
  Healthcare utilization for diabetes patients was analyzed using 2008 self-reported data (n=316) and data from electronic medical records (EMR) (n=9023), and divided whether or not care was described in the Dutch type 2 diabetes multidisciplinary healthcare standard.
  
  
  RESULTS
  On average 4.3 different disciplines of healthcare providers were involved in the care for diabetes patients. Ninety-six percent contacted a GP-practice and 63% an ophthalmologist, 24% an internist, 32% a physiotherapist and 23% a dietician. Diabetes patients had on average 9.3 contacts with GP-practice of which 53% were included in the healthcare standard. Only a limited part of total healthcare utilization of diabetes patients was included in the healthcare standard and therefore theoretically included in DMPs.
  
  
  CONCLUSIONS
  Organizing the care for diabetics in a DMP might harm the coordination and quality of all healthcare for diabetics. DMPs should be integrated in the overall organization of care.
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
authors.forename: Christel E
authors.initials: CE
authors.lastname: van Dijk
authors.forename: Robert A
authors.initials: RA
authors.lastname: Verheij
authors.forename: Ilse C S
authors.initials: IC
authors.lastname: Swinkels
authors.forename: Mieke
authors.initials: M
authors.lastname: Rijken
authors.forename: François G
authors.initials: FG
authors.lastname: Schellevis
authors.forename: Peter P
authors.initials: PP
authors.lastname: Groenewegen
authors.forename: Dinny H
authors.initials: DH
authors.lastname: de Bakker