title: Evaluation of a program to strengthen general practice care for patients with chronic disease in Germany.
abstract: A program to strengthen general practice care for patients with chronic disease was offered in Germany. Enrollment was a free individual choice for both patients and physicians. This study aimed to examine the long-term impact of this program.
  
  
  
  Two comparative evaluations were done, at 4 and 5 years (T1 and T2) after start of the program. In each year, patients in the program were compared with patients in usual care. Measures were based on routinely collected data and concerned 11 aspects of primary care and hospital care. Study groups were compared, using regression analysis adjusted for confounders and clustering.
  
  
  
  Data on 1.187.597 and 1.591.017 eligible patients were available for the analysis for T1 and T2, respectively. Compared to usual care, the program was associated with more visits to the GP per patient (adjusted difference at T2: +1.98), more drugs prescribed per patient (+0.071), lower percentage of drugs that should be avoided (-0.699), and lower yearly medication costs per patient (-85.39 euro). The number of referrals to ambulatory specialists, either with or without referral from GP, was reduced at T2. In hospital care, the program was associated with fewer hospital admissions per patient per year (-0.017) and fewer avoidable hospital admissions of all admissions (-1.165%). Total hospital costs were slightly higher in T1, but lower in T2. Days in hospital and number of readmissions were lower at T2 only.
  
  
  
  The program has increased the role of general practice in healthcare for patients who chose to be included in the program of intensified general practice care.
authors.affiliation: Heidelberg University Hospital, Department General Practice and Health Services Research, Marsilius-Arkaden, Turm West, INF 130.3, 69120, Heidelberg, Germany. Michel.Wensing@med.uni-heidelberg.de.
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
authors.affiliation: Heidelberg University Hospital, Department General Practice and Health Services Research, Marsilius-Arkaden, Turm West, INF 130.3, 69120, Heidelberg, Germany.|AQUA Institute for Applied Quality Improvement and Research in Health Care, Göttingen, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Szecsenyi
authors.affiliation: Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Stock
authors.affiliation: AQUA Institute for Applied Quality Improvement and Research in Health Care, Göttingen, Germany.
authors.forename: Petra
authors.initials: P
authors.lastname: Kaufmann Kolle
authors.affiliation: Heidelberg University Hospital, Department General Practice and Health Services Research, Marsilius-Arkaden, Turm West, INF 130.3, 69120, Heidelberg, Germany.
authors.forename: Gunter
authors.initials: G
authors.lastname: Laux
mesh_terms: D002908:Chronic Disease / Q000628:therapy*; D003430:Cross-Sectional Studies; D005260:Female; D058006:General Practice / Q000191:economics / Q000458:organization & administration / Q000592:standards*; D005858:Germany / Q000453:epidemiology; D017721:Hospital Costs; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D058996:Quality Improvement / Q000458:organization & administration* / Q000592:standards; D011787:Quality of Health Care / Q000458:organization & administration* / Q000592:standards*; D012017:Referral and Consultation; D013038:Specialization
keywords: Chronic disease; Evaluation research; Health services research; Practice management; Primary care