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Health care in and outside a DMP for type 2 diabetes mellitus in Germany-results of an insurance customer survey focussing on differences in general education status

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Abstract

Aim

The Disease Management Programmes (DMPs) introduced in Germany since 2003 are intended to improve health care for the chronically ill. Whether they do this is currently being investigated in various evaluation settings. In order to assess possible changes in the process quality from the point of view of patients, the BARMER health insurance company conducted a national postal survey in Germany in 2007 of its customers with diabetes mellitus type 2 in order to compare programme participants and non-participants. This evaluation is a sub-analysis intended to clarify whether the utilisation, acceptability and perceived benefits of the programme differ as a result of educational status.

Subjects and Methods

A nationally representative random sample was drawn from BARMER insurance customers with type 2 diabetes, aged 45–79 years. Questionnaires were evaluated from 38.5% of the sample (DMP-participant respondents: n = 2,158; non-participant respondents: n = 2,182).

Results

A lower educational status was related among other things with increased morbidity, a poorer level of information and also a less well-developed “preventive attitude” to the disease. The finding that 49% of participants had a higher school qualification compared with 45% of non-participants, although significant, is less pronounced than the differences found between DMP participants and non-participants for other values analysed. A social influence could be found concerning the differences in treatment provided within the programme. A multivariate analysis shows that both the participation in the programme and higher levels of education have independent positive effects on the satisfaction with health status, with the effect of programme participation being stronger.

Conclusions

It can be assumed that the clear differences established between the groups of DMP participants and non-participants can in no way be explained solely by the comparatively small difference related to school education. Patients obviously appreciate the fact that the health personnel and the insurance company are paying increased interest to their disease, and this is true to an increased degree for participants with only basic schooling. Although overall this group is significantly under-represented among the participants, they reported to an increased degree that they were profiting from the programme.

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Notes

  1. Standard instruments for evaluating health-related quality of life, such as SF 12 or SF 36 (Bullinger and Morfeld 2004), are not specifically designed with diabetes in mind. With no validated standards for diabetes-specific instruments (cf. Hirsch 1996, Altenhofen et al. 2005), items were included that were tailored to diabetes type 2.

  2. In addition, another type of standardisation was tested according to age and gender. Assuming that non-participants and participants would be similar in terms of both age and gender structure (which is not in fact the real situation, but which leads to full control of these factors), the non-participants were standardised separately to the participants for gender according to age. This led to slightly different values for proportions behind the decimal point without influencing the significance values determined.

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Authors and Affiliations

  1. Department of Health, Nursing, Management, University of Applied Sciences Neubrandenburg, Post Box 11 01 21, 17041, Neubrandenburg, Germany

    Thomas Elkeles

  2. Research, Consulting Service + Evaluation (FB+E), Berlin, Germany

    Wolf Kirschner

  3. BARMER Health Insurance, Wuppertal, Germany

    Christian Graf & Petra Kellermann-Mühlhoff

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  1. Thomas Elkeles
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  2. Wolf Kirschner
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  3. Christian Graf
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  4. Petra Kellermann-Mühlhoff
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Correspondence to Thomas Elkeles.

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Elkeles, T., Kirschner, W., Graf, C. et al. Health care in and outside a DMP for type 2 diabetes mellitus in Germany-results of an insurance customer survey focussing on differences in general education status. J Public Health 17, 205–216 (2009). https://doi.org/10.1007/s10389-008-0234-5

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