title: [Ambulatory care of patients with asthma in Germany and disease management program for asthma from the view of statutory health insured patients. A postal survey of statutory health insured patients].
abstract: BACKGROUND
  In spite of a decline in mortality due to asthma in Germany various studies point towards deficits in asthma care. Our investigation should collect data about ambulatory care from the view of statutory health insured patients (SHI), who participate in the disease management program asthma (DMP-P) or do not (NP). Primary question was, if there is a difference between asthma control. Secondary questions referred to process parameters.
  
  
  METHODS
  The postal inquiry was conducted in 2010 with 8000 randomly selected members of a SHI company with asthma (4000 DMP-P and 4000 NP). The descriptive evaluation of categorical items was performed with cross-tables. The absolute risk reduction (ARR) and 97.5 %-confidence interval (CI; multiple level 5 %) was used to evaluate the primary question. Secondary questions were analysed by ARR and 95 %-CI.
  
  
  RESULTS
  The response rate of the questionnaire accounted for 31.1 % (2565). 49.2 % of all respondents lived with an uncontrolled asthma with no differences between DMP-P and NP (ARR -2.7 %, 97.5 %-CI -7.9 -2.4 %). Results did not alter after adjustment for sex and age. The secondary questions revealed significant differences (DMP-P vs. NP) in participation in asthma trainings 50.6 vs. 32.3 %, use of a peak-flow-meter 49.3 vs. 25.3 % and asthma action plan within reach 21.7 vs. 11.0 %.
  
  
  CONCLUSIONS
  Half of all respondents lives selfreported - even in the DMP-group - with an uncontrolled asthma. Process parameters showed better results in the DMP-group. It can be considered, that the DMP has its desired effect on patient-centered care, but does not lead to a better therapeutic outcome. Explanations can only be assumed: insufficient impact of the process parameters on the outcome, patient behavior, that minimizes a possible effect, or selection effects, if patients, who were more sick and at the same time more motivated, were mainly included in the DMP. These aspects should be addressed in studies with a prospective design.
authors.affiliation: Institut für Allgemeinmedizin und Familienmedizin, Fakultät für Gesundheit, Universität Witten / Herdecke.
authors.forename: B
authors.initials: B
authors.lastname: Bücker
authors.affiliation: Institut für Allgemeinmedizin und Familienmedizin, Fakultät für Gesundheit, Universität Witten / Herdecke.
authors.forename: S
authors.initials: S
authors.lastname: Löscher
authors.affiliation: Institut für Allgemeinmedizin, Medizinische Fakultät der Heinrich-Heine-Universität Düsseldorf, Universitätsklinikum Düsseldorf.
authors.forename: C
authors.initials: C
authors.lastname: Schürer
authors.affiliation: Institut für Medizinische Biometrie und Epidemiologie, Fakultät für Gesundheit, Universität Witten / Herdecke.
authors.forename: K
authors.initials: K
authors.lastname: Schaper
authors.affiliation: Institut für Allgemeinmedizin, Medizinische Fakultät der Heinrich-Heine-Universität Düsseldorf, Universitätsklinikum Düsseldorf.
authors.forename: H-H
authors.initials: HH
authors.lastname: Abholz
authors.affiliation: Institut für Allgemeinmedizin, Medizinische Fakultät der Heinrich-Heine-Universität Düsseldorf, Universitätsklinikum Düsseldorf.
authors.forename: S
authors.initials: S
authors.lastname: Wilm
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D001249:Asthma / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D005858:Germany / Q000453:epidemiology; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000706:statistics & numerical data*; D015995:Prevalence; D012307:Risk Factors; D012648:Self Care / Q000706:statistics & numerical data*; D014600:Utilization Review; D055815:Young Adult