Sunday, March 13, 2005

Good News for skeptics of Disease management Programs

Dr.Autumn Galbreath, of University of Texas Medical School in San Antonio, presented a paper at the American Heart Association meeting which gave little for advocates of these programs to be pleased about.
For the beginning I thought this "movement" was basically fluff and hype and a plan for managed care organizations to make money by saving money for the large insurers and HMOs.Drug companies also promoted these programs which seemed to me to be a thinly disguised promotion program for various of their products.
Dr.Galbreath's findings indicate that there is no savings.This study was large and was a Randomized trial, attributes that apparently most if not all of previous papers that hyped the programs did not share.
There was no difference in hospitalizations,procedures, office or ER visits or medication cost.There was a slightly longer survival in the disease management group versus the control group in this 18 month study involving 1,069 patients. The mechanism by which this occurred is not known.I suppose if some physicians were not aware of the state of the art treatment, then contact with the case manage nurse might have brought about a beneficial alteration in some patient's care.But this type study is too coarse grained to tease out that level of detail.
When and if I get CHF or asthma or Parkinsons disease, I want to be managed by a experienced cardiologist,pulmonary doc, or neurologist whose time I don't want wasted by phone call from a nurse manager armed with guidelines and flow sheets and a good telephone voice.

1 comment:

NC Yellow Dog said...

For the beginning I thought this "movement" was basically fluff and hype and a plan for managed care organizations to make money by saving money for the large insurers and HMOs...

I was around at the beginning of this and thought the same thing...especially after the hospital I worked in closed a brand-new diabetes specialty program because you apparently can't make money off diabetics-costs too much to take care of them.