The role of disease management programs in the health behavior of chronically ill patients.
Cramm JM., Adams SA., Walters BH., Tsiachristas A., Bal R., Huijsman R., Rutten-Van Mölken MP., Nieboer AP.
OBJECTIVE: Investigate the effects of disease management program (DMP) implementation on physical activity, smoking, and physical quality of life among chronically ill patients. METHODS: This study used a mixed-methods approach involving qualitative (35 interviews with project managers) and quantitative (survey of patients from 18 DMPs) data collection. Questionnaire response rates were 51% (2010; 2619/5108) at T0 and 47% (2011; 2191/4693) at T1. RESULTS: Physical activity and the percentage of smokers improved significantly over time, whereas physical quality of life declined. After adjusting for patients' physical quality of life at T0, age, educational level, marital status, and gender, physical activity at T0 (p<0.01), changes in physical activity (p<0.001), and percentage of smokers at T0 (p<0.05) predicted physical quality of life at T1. Project managers reported that DMPs improved patient-professional interaction. The ability to set more concrete targets improved patients' health behaviors. CONCLUSIONS: DMPs appear to improve physical activity among chronically ill patients over time. Furthermore, (changes in) health behavior are important for the physical quality of life of chronically ill patients. PRACTICE IMPLICATIONS: Redesigning care systems and implementing DMPs based on the chronic care model may improve health behavior among chronically ill patients.