Evaluation Study DMP Diabetes
A disease management program (DMP) for patients with type 2 diabetes was launched at the beginning of 2006. Because of a lack of valid data regarding the effectiveness of DMPs, the Institute of General Practice, Family Medicine and Preventive Medicine at the Paracelsus University encouraged the policy makers to accompany the implementation of the DMP with a randomized controlled trial. Following tough negotiations with national insurance representatives and intense efforts to win sponsors for the study (Salzburger Sparkasse, Roche Diagnostics); it was finally possible to launch the joint venture in July 2007.
The study protocol was approved by the Ethics Committee of the province of Salzburg in 2006. The study was registered under the number ISRCTN27414162at Current Controlled Trials Ltd. The study protocol was published in the international “Trials” journal at the beginning of 2008 (see publication list).
Between April and June 2007, all general practice surgeries of the province of Salzburg were invited to participate in the study. Of the 271 MDs contacted, 98 agreed to take part. Almost 1,500 patients could be recruited for the study between July and October 2007. This DMP study is thus one of the largest randomized controlled trials ever carried out in the evaluation of DMPs, and the main results have been published in in BMC Family Practice.
DMP follow-up
Following completion of the randomized controlled trial on the effectiveness of the DMP for type 2 diabetes, participants continue to be monitored in a follow-up study. The long-term impact of the DMP on metabolic control and the complication rate will be investigated. In the first year, the study was supported by the Jubiläumsfonds der Österreichischen Nationalbank (Austrian National Bank).
DISMEVAL
Developing and validating disease management evaluation methods for European health care systems http://www.dismeval.eu/
This project brings together a multi-disciplinary team of 10 partners in 7 EU countries (Germany, UK, France, Spain, Netherlands, Denmark and Austria). It is funded by the European Commission’s 7th Framework Programme Theme Health and runs for three years, from 1 January 2009 to 31 December 2011. Aims of the project are to review current approaches to chronic care and explore the policy context for chronic disease management in Europe and to assess options for approaches to disease management evaluation and to test and validate methods for evaluation of Disease Management Programmes. Best practice should be identified to be able to develop recommendations for disease management evaluation for policymakers and researchers.
In Austria, the project received start-up support from the Forschungsförderungsgesellschaft (Research Promotion Agency).
“Aktivtreff Diabetes”
Disease management programs (DMPs) for diabetes have shown only minor improvements regarding metabolic control, guideline adherent care and the quality of life of diabetic patients. Patient education is the most effective factor and should therefore be strengthened. Peer support is a promising approach to do so. The “Aktivtreff Diabetes”-study aims to investigate whether a standardized, reproducible peer support program improves diabetes care and patient self management. All patients currently enrolled in the DMP “Therapie aktiv” will be invited to participate in the study.
The peer support program (PSP) will be evaluated by a cluster-randomized controlled trial. In the intervention surgeries the PSP is installed by training one patient as peer supporter. Training and peer support action are standardized to assure reproducibility. Peer groups meet every week for exercise. Twice a month exercise is followed by a meeting. Patients are motivated to address personal, social and emotional issues and to propose treatment goals. The group regularly gets professional support. Patients in the control group receive standard care according to the DMP „Therapie aktiv“, which includes usual care according to international guidelines regarding diagnostics and treatment of diabetes. Primary outcome measure is a decrease in HbA1c. Secondary outcome measures are improved diabetes management self-efficacy, higher quality of life and improved control of cardiovascular risk, weight reduction, smoking cessation, and cost-efficacy.
This project is supported by a BRIDGES Grant from the International Diabetes Federation. BRIDGES, an International Diabetes Federation project, is supported by an educational grant from Eli Lilly and Company. The implementation will be conducted in cooperation with AVOS (Arbeitskreis für Vorsorgemedizin Salzburg). The study started in June 2010 and will run through May 2013.
Evidence-based Medicine (EBM) Research Service
This project gives specialists and general practitioners the opportunity to send queries arising in routine medical practice to the Institute via an internet platform. Specially trained staff researches these queries in relevant medical databases (PubMed, Electronic Journals Library, etc.), and promptly communicates the latest findings in evidence-based research. REM was made possible through collaboration with the generics specialist Actavis Ltd.
The service was made accessible to all practicing doctors in July 2007. Meanwhile, over 1200 physicians are registered from Austria and Switzerland. A team of one full-time and two part-time research fellows are working in the project. Over 600 requests have been filed to date.
Preoperative diagnosis
It is well known that patients undergo a large number of unnecessary tests and double examinations (e.g. by GP and hospital) before surgery within the framework of so-called preoperative diagnostics. This does not only lead to unnecessary expenditure in the healthcare system but also to a burden for patients. Previously this has not been quantified. In collaboration with the Schwarzach Hospital Department of Anaesthesiology, the Institute of General Practice, Family Medicine and Preventive Medicine is conducting a study to collect and quantify preoperative diagnosis. Data has been collected from 1,500 patients undergoing surgery at the district hospital in Schwarzach, Austria. The survey was completed in December 2007. The publication of data is currently in progress. The findings of this study also contribute to the evaluation of the Reformpool-Project, which was implemented in January 2008 in Salzburg to optimize and rationalize the preoperative diagnostics by the web-based guideline PROP. The Institute of General Practice, Family Medicine and Preventive Medicine was assigned to evaluate the data collected in this Reform-Pool-Project by the State Health Funds of Salzburg. The evaluation report is currently under completion. To furthermore investigate the influence of the guideline PROP, a follow up study was carried out in the Hospital of Schwarzach. Data analysis is currently under progress.
Project on Medication Errors in Primary Care
The Linneaus Euro-PC collaboration is a co-ordination action funded by the European Union Framework 7 Programme to address the deficit in activity related to patient safety in primary care. The project is organized into nine Work Packages (see http://www.linneaus-pc.eu// for further details), and the Paracelsus Medical University, Austria is focusing on medication errors in primary care settings. Through collaboration facilitated by the network, we aim to develop an applied research agenda which will increase our understanding of preventable adverse drug events that originate in primary care, and facilitate the sharing of data on the epidemiology and underlying causes of these events between European countries. It will also focus on identifying interventions which may improve medication safety in primary care and develop plans to evaluate the health and cost impacts of these interventions to improve medication safety. Additional information can be obtained by contacting Dr. Miriam Lainer at miriam.lainer@pmu.ac.at or Dr. Anna Vögele (anna.voegele@pmu.ac.at).
REVAN
REVAN stands for „eating healthily from day one“. The goal of the project is to ensure a well-balanced diet during pregnancy in order to provide both mother and baby with all the important nutrients and to guarantee that the baby has an ideal beginning of life. It is known that pregnant women are very interested in various health-related topics and are much more likely to change their behaviour, e.g. improving their diet. The Salzburg GKK (public health insurance) offers workshops free of charge to all pregnant women and supplies them with the latest scientific findings about the right nutrition when becoming a mother.
The Institute for general practice evaluates the effectiveness of the workshops.
IQuaB
Interreg IV Italy-Austria is a European territorial cooperation program for cross-border cooperation between Italy and Austria. It is funded by the European Regional Development Fund. In the framework of the Interreg IV program we conduct a survey in cooperation with the Academy for General Practice South Tirol, called “IQuaB” (Improvement of Quality by Benchmarking).The aim of this study is to improve the quality of care in chronically ill patients in general practice. Over a period of 3 years (2011 to 2014) we are going to collect data about the quality of care of the most common chronic diseases (diabetes mellitus type 2, hypertension, coronary artery disease, peripheral vascular occlusive disease, cerebrovascular disease, chronic obstructive pulmonary disease, heart failure and atrial fibrillation). After a first collection of data, the participating doctors (60 general practitioners in South Tirol and Salzburg) will get feedback about the quality of care in their own practice compared to the other participating practices. Subsequently the quality should be improved by the implementation of quality circles with the participating doctors.
