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R. Griebenow 1,2 , I. Schwang 1 , B. Hagen 3 , L. Altenhofen 3 , W. Haß 3

7th International Conference on Medical Regulation November 2006, Wellington, New Zealand. Continuing Medical Education (CME) Being Part of a Disease Manage-ment Programme (DMP): Will Prescription Behaviour Change?. R. Griebenow 1,2 , I. Schwang 1 , B. Hagen 3 , L. Altenhofen 3 , W. Haß 3.

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R. Griebenow 1,2 , I. Schwang 1 , B. Hagen 3 , L. Altenhofen 3 , W. Haß 3

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  1. 7th International Conference on Medical Regulation November 2006, Wellington, New Zealand 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.  55 56 - 65 66 - 75  76 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. Men Women DMP Coronary Heart Disease NorthrhineKnown and Newly Diagnosed Comorbidities %

  4. Men Women 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. Men Women DMP Coronary Heart Disease NorthrhineMedication of Patients with Heart Failure %

  6. Beta blockers ACE inhibitors Calcium-channelblockers DMP Coronary Heart Disease NorthrhineAntihypertensive Medication of Patients with Heart Failure n: 7,963 n: 5,119 n: 1,047 n: 99 %

  7. Beta blockers + ACE inhibitors Beta blockers + ACE inhibitors +Calcium-channel blockers DMP Coronary Heart Disease NorthrhineCombined Antihypertensive Medication of Patients with Heart Failure %

  8. Men Women DMP Coronary Heart Disease NorthrhineCalcium-Channel Blockers and Age of Patients Years Total number of patients: 20,148 (12,011 men; 8,137 women) %

  9. Systolic (mean  sd) Diastolic 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. Participation No participation 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. Systolic blood pressure Diastolic blood pressure (mean  sd) 100 50 150 250 200 DMP Coronary Heart Disease NorthrhineCME 2005/2, Blood Pressure and Cholesterol of Patients with Heart Failure mm Hg Total cholesterol LDL cholesterol (mean  sd) mg/dl

  13. Systolic (mean  sd) Diastolic DMP Coronary Heart Disease Northrhine Blood Pressure of Patients with Heart Failure in 2005/2 Participation No Participation mm Hg

  14. Systolic (mean  sd) Diastolic DMP Coronary Heart Disease Northrhine Blood Pressure of Patients with Heart Failure in 2006/1 Participation No Participation mm Hg

  15. Beta blockers ACE inhibitors Calcium-channel blockers n: 1,103 n: 812 n: 167 n: 15 n: 5,737 n: 3,662 n: 726 n: 65 DMP Coronary Heart Disease NorthrhineAntihypertensive Medication of Patients with Heart Failure in 2005/2 Participation No Participation %

  16. Beta blockers ACE inhibitors Calcium-channel blockers n: 1,314 n: 979 n: 209 n: 19 n: 6,649 n: 4,140 n: 838 n: 80 DMP Coronary Heart Disease NorthrhineAntihypertensive 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. Beta blockers + ACE inhibitors Beta blockers + ACE inhibitors + Calcium-channel blockers DMP Coronary Heart Disease NorthrhineAntihypertensive 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. Beta blockers + ACE inhibitors Beta blockers + ACE inhibitors + Calcium-channel blockers DMP Coronary Heart Disease NorthrhineAntihypertensive Medication of Patients with Heart Failure in 2006/1 Participation No Participation %

  19. Participation No participation DMP Coronary Heart Disease NorthrhineAntihypertensive Medication of Patients* with Heart Failure in 2005/2 *: Combined medication (beta blockers + ACE inhibitors) of 3,602 patients treated additionally with calcium-channel blockers p: 333 np: 1,650 p: 237 np: 1,127 p: 38 np: 197 p: 6 np: 14 %

  20. Participation No participation DMP Coronary Heart Disease NorthrhineAntihypertensive Medication of Patients* with Heart Failure in 2006/1 *: Combined medication (beta blockers + ACE inhibitors) of 4,315 patients treated additionally 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.

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