Disease Management Programs: Pros and Cons

On the con side, expensive, time consuming disease management programs (DMPs) don't necessarily benefit patients in the long term, according to a German study. Roland Linder, a professor at Deutsches Aerzteblatt International, and his group set out to determine if diabetes-related conditions and emergency inpatient hospital admissions occurred less frequently in patients in a DMP.

The researchers, who presented their findings in a recent issue of Deutsches Arzteblatt International, found that participating in the DMP didn't confer any clear medical benefits. In fact, researchers found, patients in DMPs tended to get even more prescriptions filled and make more use of more healthcare services than those not in the DMP. All in all, the authors said they felt the T2DM (Type 2 diabetes mellitus) DMP in Germany should be discontinued.

Medical experts in the U.S. don't necessarily feel the same way.

A comprehensive disease management program in which an individual sees many members of a team can pay off in the long run, says Jonathan Waitman, MD, of NewYork-Presbyterian/Weill Cornell Medical Center in New York City.

"Complications can happen down the road and intervention may not pay dividends for years and years," Waitman says. "While a DMP may not yield benefits in a short period of time, it may prevent morbidity down the line."

He feels that DMP programs can be beneficial. "A multi-disciplinary team to manage the disease can significantly improve compliance with the program and can confer long term benefits," Waitman says.

Helping diabetics keep on top of potential health problems by having them see specialists as varied as ophthalmologists and nephrologists is only one benefit of a disease management program, according to Waitman. It also helps keep them on track and organized about the many facets of their medical care, which can be daunting with a disease like diabetes.

Patient education, a crucial tool in managing diabetes, can be ongoing and time consuming, and not all physicians are able to take enough time with each patient to impart all the necessary information. That's where a certified diabetes educator or registered dietitian comes in as part of a DMP.

"Our educators can spend more time with a patient," explains Gerald Bernstein, MD, of the Friedman Diabetes Institute in New York City.

Other crucial members in a team that cares for a person with diabetes are an exercise physiologist and possibly a psychologist who can help a person work through his emotions as he confronts a lifelong illness.

"Overall, a disease management program can give a person the best possible opportunity for preventing the complications that can occur with diabetes," Bernstein says.

"Question hangs over disease management programs." 24 March 2011. Medical News Today.