Structured patient education for out-patients with hypertension in general practice: a model project in Germany.

In a model project, office-based physicians in two regions of Germany provided a structured treatment and teaching programme for out-patients with hypertension. The project was carried out in co-operation with the German Hypertension League and designed to evaluate the practicability and efficacy of the implementation in routine primary health care. A total of 111 primary health care practices in two German districts who had participated in a training course were interviewed. In 43 of these offices documented data of all patients who had received the standardised treatment and teaching were evaluated. The programme was well received by the physicians of which 81% rated the training course and 93% the teaching material as 'very good' or 'good'. A total of 466 patients were trained. Data collected on 272 patients (22 weeks after the intervention) demonstrated the efficacy of the programme at treatment level: reduction of body weight (2 kg, P < 0.001) and blood pressure (from systolic 158+/-18 to 148+/-17 mm Hg, P < 0.001; diastolic 91 +/-9 to 86+/-9, P < 0.001). Sixty-five per cent of patients learned for the first time how to perform blood pressure self-monitoring during the programme. The number of blood pressure readings by the patients' increased significantly from 1+/-3 measurements per week before, to 8+/-7 measurements per week after the programme (P < 0.001). The results of the study demonstrate the practicability and efficacy of the implementation of the programme for patients with hypertension into routine primary health care.

Structured treatment and teaching programme for type 2 diabetic patients on conventional insulin treatment: evaluation of reimbursement policy.

The aim of the study was to evaluate the practicability and efficacy of a structured treatment and teaching programme (STTP) for type 2 diabetic outpatients on conventional insulin treatment after introducing remuneration for physicians. Reimbursement policy for the STTP was introduced in the state of Brandenburg, Germany, in July 1993. Between August 1993 and February 1994, 108 physicians and their assistants participated in a postgraduate seminar, which is a prerequisite for remuneration. A standardised interview was performed with 103 physicians and their paramedical personnel. Twenty of the practices who had performed STTP were visited in order to collect data on all the patients who had participated in the programme up to September, 1994. Within the first year already 10% of the target group of physicians participated in the seminars. The seminar and the programme were very well accepted. An improvement of HbA1c levels was observed in patients who had started insulin treatment (n = 35: 9.7 +/- 1.6% of total Hb before, 8.2 +/- 1.3% of total Hb after the programme) and in those who were already being treated with insulin before the STTP (n = 125: 9.6 +/- 2.5% of total Hb before, 8.1 +/- 1.4% of total Hb after the programme). The results of the study demonstrate the efficacy and practicability of an STTP for type 2 diabetic patients on conventional insulin therapy in ambulatory health care.

Three years' experience after national introduction of teaching programs for type II diabetic patients in Germany: how to train general practitioners.

Beginning in July 1991, office-based physicians in Germany were remunerated for providing a structured treatment and teaching program to non-insulin-treated type II diabetic patients. The treatment and teaching program is based upon the respective recommendations of the German Diabetes Association. This article describes the structure of the program and the courses for general practitioners and their nurses. The prospective studies proving the beneficial effects of the program are summarized.

Evaluation of a structured treatment and teaching program for non-insulin-treated type II diabetic outpatients in Germany after the nationwide introduction of reimbursement policy for physicians.

OBJECTIVE: To evaluate the practicability and efficacy of a structured treatment and teaching program for non-insulin-treated type II diabetic patients in routine primary health care. RESEARCH DESIGN AND METHODS: All physicians (n = 139) and their office staffs in Hamburg, Germany, who had participated in a special training course from 1 April 1991 to 31 December 1991 were contacted for a standardized interview. A random sample of 17 of these offices was selected for office visits during which the documented data of all patients who had received the standardized treatment and teaching in the same period were collected and evaluated. RESULTS: The program was well received by the physicians, and the data collected on 179 patients (5.1 mo median after the intervention) demonstrated the efficacy of the program at the treatment level: reduction of body weight (mean 2.8 kg, P < 0.0001) and HbA1c levels (from 8.11 +/- 1.68 to 7.47 +/- 1.64%, P < 0.0001) was substantial. The individual prescribed volume of oral antidiabetic agents was approximately 50% lower after patient attendance of the program (significant decrease from 1.41 +/- 1.42 to 0.76 +/- 1.11 tablets/patient/day, P < 0.0001). The proportion of patients treated with oral antidiabetic drugs decreased from 63 to 42% (P < 0.0001). CONCLUSIONS: Subsequent to the introduction of nationwide remuneration of outpatient education for type II diabetic patients by office-based physicians, a relevant improvement was observed in the quality of care, comparable with the effects of the program in a previous prospective controlled trial.