Vortrag Conference Medical Regulation

1
Continuing Medical Education (CME) Being Part of
a Disease Manage-ment Programme (DMP) Will
Prescription Behaviour Change?
R. Griebenow1,2, I. Schwang1,B. Hagen3, L.
Altenhofen3 , W. Haß3
1 University Hospital Cologne, Internal Medicine
II 2 Chamber of Physicians Northrhine,
Düsseldorf 3 Central Research Institute of
Ambulatory Health Care in Germany, DMP Office,
Cologne
2
DMP Coronary Heart Disease NorthrhinePatient
Age, Gender and CHD Duration
10
Men(50,878)
Patient age (years)
26
22
43

• Total number of patients 79,656
• Men 64
• Mean age 70.2 ? 9.8 Years
• CHD duration 8.0 ? 6.6 Years
• CHD diagnosed before age of 60 38
• Number of physicians 4,284
• Follow-up documentation between January and
  June 2006

6
Women(28,778)
15
42
37
3
DMP Coronary Heart Disease NorthrhineKnown and
Newly Diagnosed Comorbidities

4
DMP Coronary Heart Disease NorthrhinePatients
with Heart Failure Classified by NYHA Grades
Total number of patients 14,228 (8,142 men
6,086 women)

5
DMP Coronary Heart Disease NorthrhineMedication
of Patients with Heart Failure

6
DMP Coronary Heart Disease NorthrhineAntihyperten
sive Medication of Patients with Heart Failure
n 7,963
n 5,119
n 1,047
n 99

7
DMP Coronary Heart Disease NorthrhineCombined
Antihypertensive Medication of Patients with
Heart Failure

8
DMP Coronary Heart Disease NorthrhineCalcium-Chan
nel Blockers and Age of Patients
Years
Total number of patients 20,148 (12,011 men
8,137 women)

9
DMP Coronary Heart Disease NorthrhineBlood
Pressure of Patients with Heart Failure
mm Hg
10
DMP Coronary Heart Disease NorthrhineCME Report
2005/2 Calcium-Channel Blockers Basic Data

• CME-Participation No Participation
• Physicians 423 (9.9) 3,841
• Patients in 2005/2 10,453 (15.6) 56,620
• Heart failure 2,097 (20.1) 10,190 (18.0)
• Men 1,233 (58.8) 5,775 (56.7)
• Mean age (years) 72.9 ? 9.0 73.1 ? 9.2
• Follow-up documentation between July and
  December 2005
• Patients with heart failure only

11
DMP Coronary Heart Disease Northrhine CME 2005/2
and Comorbidities of Patients with Heart Failure
Total number of patients 67,073 (p 10,453 np
56,620)

12
DMP Coronary Heart Disease Northrhine CME
2005/2, Blood Pressure and Cholesterol of
Patients with Heart Failure
mm Hg
Total cholesterol
LDL cholesterol (mean ? sd)
mg/dl
13
DMP Coronary Heart Disease Northrhine Blood
Pressure of Patients with Heart Failure in 2005/2
Participation
No Participation
mm Hg
14
DMP Coronary Heart Disease Northrhine Blood
Pressure of Patients with Heart Failure in 2006/1
Participation
No Participation
mm Hg
15
DMP Coronary Heart Disease Northrhine
Antihypertensive Medication of Patients with
Heart Failure in 2005/2
Participation
No Participation

16
DMP Coronary Heart Disease Northrhine
Antihypertensive Medication of Patients with
Heart Failure in 2006/1
Participation
Patients with heart failure and a follow-up
documentation between January and June
2006 14,228 (2,521 patients of physicians who
took part in CME 2005/2)
No Participation

17
DMP Coronary Heart Disease NorthrhineAntihyperten
sive Medication of Patients with Heart Failure in
2005/2
Participation
53,6
NYHA 1
14,5
52,2
NYHA 2
13,8
47,9
NYHA 3
10,2
66,7
NYHA 4
20
No Participation
49
NYHA 1
13,4
53,9
NYHA 2
14,4
57,9
NYHA 3
13,2
63,1
NYHA 4
20

0
20
40
60
80
100
18
DMP Coronary Heart Disease Northrhine
Antihypertensive Medication of Patients with
Heart Failure in 2006/1
Participation
No Participation

19
DMP Coronary Heart Disease Northrhine
Antihypertensive Medication of Patients with
Heart Failure in 2005/2
Combined medication (beta blockers ACE
inhibitors) of 3,602 patients treated additionall
y with calcium-channel blockers
p 333 np 1,650
p 237 np 1,127
p 38 np 197
p 6 np 14

20
DMP Coronary Heart Disease Northrhine
Antihypertensive Medication of Patients with
Heart Failure in 2006/1
Combined medication (beta blockers ACE
inhibitors) of 4,315 patients treated additionall
y with calcium-channel blockers
p 389 np 2,018
p 282 np 1,299
p 51 np 253
p 4 np 19

21
Conclusions

• The proportion of patients with heart failure not
  receiving the combination of ACE-inhibitor and
  Beta-blocker (as recommended by all international
  guidelines) is still inacceptably high.
• Low blood pressure cannot explain this finding.
• Instead, the prescription rate of Calcium channel
  blockers (which are not recommended by the
  guidelines) suggests inadequate prescription
  patterns
• After the CME article had been issued, the
  prescription of combination therapy has increased
  in the participant and non-participant group.
• In how far DMP associated CME articles are able
  to induce changes in prescription behaviour could
  only become apparent after a longer observation
  period.