Disease management programs for patients with COPD in Germany: a longitudinal evaluation of routinely collected patient records.
BACKGROUND
The primary aim of the disease management program (DMP) for patients with COPD is to improve health outcomes and thereby to reduce overall costs. Six years after its introduction in Germany, no consensus has yet been reached as to whether the DMP has been effective in reaching these goals. The objective of the study was an evaluation of the DMP for COPD in Bavaria using routinely collected subject medical records.


METHODS
A longitudinal population-based study, comparing the total DMP population of up to 86,560 patients with a stable cohort of 17,549 subjects over a period of 5 years. The effect of subject dropout in the cohort is further estimated by means of inverse probability weighting.


RESULTS
The proportion of subjects in the total population who were prescribed and received treatment with oral corticosteroids declined at a constant rate of 1.0% per year (P < .001). The proportion of subjects who were given a prescription for theophylline decreased at a constant rate of 2.0% per year (P < .001). By 2012, 15.6% of the total population and 26% of the cohort had undergone self-management education. While the proportion of smokers in the total population remained constant because of the effect of newly enrolled subjects, the proportion of smokers decreased significantly even after dropout adjustment, from 29% to 21%. The occurrence of exacerbations decreased steadily at a rate of 0.9% (total population) or 0.7% (cohort) per year. While the occurrence of emergency hospital admissions decreased in the total population, an increase was observed within the cohort.


CONCLUSIONS
Summarizing all results leads to the suggestion that the German DMP for COPD has been effective in enhancing the quality of care in regard to an improved adherence to guidelines, pharmacotherapy, exacerbations, and self-management education. However, the DMP was not able to prevent an increase in emergency hospital admissions for the stable population in the cohort.
Institute of General Practice, Technische Universität München, Munich, Germany. michael.mehring@tum.de.
Michael
M
Mehring
National Association of Statutory Health Insurance Physicians of Bavaria, Munich, Germany.
Ewan
E
Donnachie
Institute of General Practice, Technische Universität München, Munich, Germany.
Johannes
J
Fexer
National Association of Statutory Health Insurance Physicians of Bavaria, Munich, Germany.
Frank
F
Hofmann
Institute of General Practice, Technische Universität München, Munich, Germany.
Antonius
A
Schneider
D000293:Adolescent; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001993:Bronchodilator Agents / Q000627:therapeutic use; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D019468:Disease Management; D005260:Female; D005541:Forced Expiratory Volume; D005858:Germany; D005938:Glucocorticoids / Q000627:therapeutic use; D006760:Hospitalization; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D015397:Program Evaluation; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D012648:Self Care; D055815:Young Adult
D000318:Adrenergic beta-Agonists; D001993:Bronchodilator Agents; D018680:Cholinergic Antagonists; D005938:Glucocorticoids
COPD; active patient participation; disease management program; emergency admission; exacerbations; general practice; guideline adherence; pharmacotherapy