What are disease management programs (DMPs)?
Disease management programs (DMPs) are structured treatment plans that aim to help people better manage their chronic disease and to maintain and improve quality of life. DMPs are also run with the general goal of improving medical treatment in the long term. They are also called “structured treatment programs.”
Statutory health insurance funds in Germany have offered DMPs in cooperation with doctors since 2002. The programs include regular doctor's appointments for consultations and medical examinations. Learning more is also a part of the programs, for example in the form of training courses for patients. Doctors who offer DMP treatment must meet certain requirements and follow defined quality standards.
In Germany, DMPs are currently available for people with these chronic diseases:
- Chronic-obstructive pulmonary disease (COPD)
- Breast cancer
- Type 1 diabetes
- Type 2 diabetes
- Coronary artery disease (CAD), including a module for chronic heart failure
People who have more than one of these diseases can participate in the DMPs for each of their diseases.
The programs are based on the guidelines issued by the German Federal Joint Committee (G-BA). G-BA is the highest decision-making body of the joint self-government of physicians, dentists, psychotherapists, hospitals and health insurance funds in Germany.
What is the aim of disease management programs?
The main aim of a DMP is to reduce the symptoms associated with a chronic disease and keep them from getting worse. Other targets include trying to prevent complications or accompanying diseases from developing.
In addition, this structured approach to treatment aims to help people cope with their disease and to show them ways of dealing with the demands of their treatment in everyday life. All of these things together aim to improve quality of life for program participants.
Disease management programs also aim to improve cooperation between the various specialists and institutions that provide care for a patient, such as family and specialist doctors, hospitals and rehabilitation centers. This is meant to ensure that the individual treatment steps are well coordinated and, for example, avoid the same medical test being done twice unnecessarily.
How is treatment provided in a disease management program?
After medical consultations and examinations, and diagnosis, the doctor will prepare an individual treatment plan based on the specifications of the DMP. This plan includes medication and other treatments, training courses and regular check-ups, some of which may be carried out by other doctors or hospitals. For example, the DMP for diabetes involves having regular eye tests in order to detect and treat possible eye damage early on.
The individual therapy steps, as well as the outcomes of tests and treatment, are documented. This is done to enable all those involved in the therapy to understand why certain decisions were made and certain measures taken, and to take this information into consideration when planning further treatment.
Patients who enroll in a DMP commit themselves to actively cooperate in their treatment – for example, by visiting a doctor every three or six months. All of the participating health care providers – including doctors, hospitals, rehabilitation centers, nurses and trainers – commit themselves to fulfill certain quality requirements and follow the defined treatment plans.
Several things are done to assure quality in a DMP. This includes documenting and evaluating patient data regularly. The doctors get feedback reports on their treatment outcomes, which are also compared with the outcomes achieved by other doctors’ practices. Doctors can also attend training courses.
If you would like to participate in a DMP, but your family doctor does not take part, you may have to change doctors.
How can I benefit from a DMP?
Chronic diseases are complex conditions and require long-term regular treatment which should be tailored to suit the patient wherever possible. Participating in a disease management program is a way to better manage your disease in the long term and improve the success of your treatment. Taking part in a DMP offers some advantages, including the following:
- People who participate in a DMP work with doctors who have specialized in treating their disease.
- The doctors involved in a DMP are well-informed about the course of your treatment and will be able to give you more personalized attention during the regular appointments than they would be able to do in a normal consultation.
- All of the therapists and carers involved, both in inpatient and outpatient treatment, are to coordinate their interventions with one another.
- Special training courses can make it easier for people with chronic diseases to actively take part in making well-informed decisions about their treatment and in finding ways to live with their disease as well as possible.
Another reason some people find a structured treatment plan helpful is that it reduces some of the time and effort involved in managing their disease. For example, they no longer have to look for suitable specialists or hospitals themselves if they do not want to.
What are the programs based on, and how are they evaluated?
The DMP contents are based on guidelines issued by the German Federal Joint Committee (Gemeinsamer Bundesausschuss, or G-BA). G-BA is the highest entity of self-governance for doctors, dentists, psychotherapists and the hospitals and health insurers in Germany. Its DMP guidelines define the key elements of the treatment and their coordination. These elements are based on the current state of medical knowledge, and include information from other evidence-based guidelines. Guidelines are a type of decision aid for doctors and patients. They aim to help ensure the best quality-assured treatment.
Because medical knowledge is continually increasing, DMP requirements have to be updated regularly. G-BA regularly commissions the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) to review the various DMPs.
What can I do if there is no DMP for my condition?
If the statutory health insurance funds in Germany do not offer a disease management program for your disease, it does not mean that you cannot have a structured treatment plan. A good doctor's practice that works in close cooperation with other therapists and institutions can also make it possible to achieve quality disease management. If you and your doctor develop a personal treatment plan that suits you, and you attend regular appointments, you will already have the fundamental elements of good disease management. Last but not least, reliable, comprehensive information can help you understand your disease better and learn how to live with it.
Gemeinsamer Bundesausschuss (G-BA). Disease-Management-Programme (DMP). July 2016.
IQWiG health information is written with the aim of helping
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