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 structure d treatment and teaching program for non-insulin-treated type II diabe tic patients in routine primary health care. RESEARCH DESIGN AND METHO DS - All physicians (n = 139) and their office staffs in Hamburg, Germ any, who had participated in a special training course from 1 April 19 91 to 31 December 1991 were contacted for a standardized interview. A random sample of 17 of these offices was selected for office visits du ring which the documented data of all patients who had received the st andardized treatment and teaching in the same period were collected an d evaluated. RESULTS - The program was well received by the physicians , and the data collected on 179 patients (5.1 mo median after the inte rvention) demonstrated the efficacy of the program at the treatment le vel: reduction of body weight (mean 2.8 kg, P < 0.0001) and HbA1c leve ls (from 8.11 +/- 1.68 to 7.47 +/- 1.64%, P < 0.000 1) was substantial . The individual prescribed volume of oral antidiabetic agents was app roximately 50% lower after patient attendance of the program (signific ant 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 out-patient educati on for type II diabetic patients by office-based physicians, a relevan t improvement was observed in the quality of care, comparable with the effects of the program in a previous prospective controlled trial.