Deutsche medizinische Wochenschrift
-
Dtsch. Med. Wochenschr. · Mar 2020
[One and a Half Decades of Disease Management Programs - Status Quo From the Point of View of General Practitioners].
In 2003, disease management programs (DMP) were established to improve the care of chronically ill outpatient patients. Since then, there has been a lot of controversy over the meaning and benefits of structured treatment programs, especially among primary care physicians. The present study examines the attitudes and experiences of general practitioners in relation to DMP, how they assess these one and a half decades after their introduction, and where DMP need to be improved. ⋯ From a primary care point of view, a substantial improvement in DMP would mean a simplification of the documentation and administration effort, better regulated and smoother cooperation with other care levels, a greater degree of decision flexibility, a greater and more differentiated offer of compulsory training, and an increased involvement of primary care experience in the process of DMP development as well as a better reward.
-
Dtsch. Med. Wochenschr. · Mar 2020
[Difficult Decisions in Therapy of Severe Stroke and Progressed Neurodegenerative Disease - Decision process in fields of limited communication and willing capability].
Severe stroke and neurodegenerative diseases often cause limitations in communication and willing capability. Decision processes in these conditions assume primarily a positive medical indication for any intervention. If not obtainable from an individual by itself, by a disposal or by a legal custodian, the presumed will of a patient has to be detected carefully. ⋯ Pain in demented persons is often underrated and undertreated. The diagnosis of dementia alone does not limit the indication for curative therapy in general. Ethical comitees or ethical visits are helpful instruments to find out an adequate decision in difficult situations.