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An Empirical Model for the Development of Disease Management Programs in General Practice

A Case Study Using Hypertension

  • Original Research Article
  • Published:
Disease Management & Health Outcomes

Abstract

Objective: The aim of this research was to develop an empirically derived methodological model for the development of disease management programs in general practice. The model was developed applying the example of hypertension.

Methods: Using a rapid appraisal framework, empirical investigations, which included structured panel discussions, face-to-face structured interviews and formal presentations, were conducted to design, test and confirm the disease management model. A broad range of stakeholders were consulted from general practice, other health providers, industry, federal government and consumers.

Results: The outcome of the research was a testable definition of disease management for hypertension, and the Australian Disease Management Approach to Hypertension in General Practice (ADAGE) for patients at low to high risk of major cardiovascular events. The central platform of this program is an information, communication technology package for risk assessment and management, plus access to a dietician commissioned by the program and a tailored suite of audiovisual and written material.

Conclusion: This study used hypertension to demonstrate a model for the development of theoretically sound disease management models for application in general practice. The ADAGE program is currently under evaluation in a cluster randomized trial of 76 general practices in South Australia and Victoria in both metropolitan and rural settings. It is anticipated that this model will contribute to the development of other disease management programs for addressing chronic disease.

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References

  1. Murray CJL, Lopez AD, editors. Global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020. Harvard (MA): Harvard University Press, 1996.

    Google Scholar 

  2. Mathers C, Vos T, Stevenson C. The burden of disease and injury in Australia. Canberra (ACT): Australian Institute of Health and Welfare, 1999.

    Google Scholar 

  3. Commonwealth Department of Health and Aged Care. Self-management the key to living with chronic disease [online]. Available from URL: http://www.health.gov.au/mediarel/yr2000/mw/mw20069.htm. [Accessed 2001 Apr 4].

  4. Power P, Aloizos J. The operating environment of general practice. In: Pegram R, editor. General practice in Australia: 2000. Canberra (ACT): Commonwealth Department of Health and Aged Care, 2000: 156–95.

    Google Scholar 

  5. Harris MF, Powell-Davies G. Integration between GPs, hospitals and community health services. In: Pegram R, editor. General practice in Australia: 2000. Canberra (ACT): Commonwealth Department of Health and Aged Care, 2000: 310–44.

    Google Scholar 

  6. Bodenheimer T. Disease management: promises and pitfalls. N Engl J Med 1999; 340: 1202–5.

    Article  PubMed  CAS  Google Scholar 

  7. Epstein RS, Sherwood LM. From outcomes research to disease management: a guide for the perplexed. Ann Intern Med 1996; 124: 832–7.

    PubMed  CAS  Google Scholar 

  8. Silagy C. Coordinated care trials. In: Pegram R, editor. General practice in Australia: 2000. Canberra (ACT): Commonwealth Department of Health and Aged Care, 2000: 470–91.

    Google Scholar 

  9. Bradley F, Wiles R, Kinmonth A-L, et al., for the SHIP Collaborative Group. Development and evaluation of complex interventions in health services research: case study of the Southampton Heart Integrated Care Project (SHIP). BMJ 1999; 318: 711–5.

    Article  PubMed  CAS  Google Scholar 

  10. Guidelines Subcommittee of the World Health Organisation—International Society of Hypertension (WHO-ISH) Mild Hypertension Liaison Committee. 1999 World Health Organisation-International Society of Hypertension Guidelines for the Management of Hypertension. J Hypertens 1999; 17: 151–83.

    Google Scholar 

  11. Australian Institute of Health and Welfare. Australia’s health 2000. The seventh biennial health report of the Australian Institute of Health and Welfare. Canberra (ACT): Australian Institute of Health and Welfare, 2000.

    Google Scholar 

  12. University of Adelaide. Human Research Ethics Committee [online]. Available from URL: http://www.adelaide.edu.au/secretary/staff/ethics/human/policyhe.html [Accessed 2002 Jul 2].

  13. Ong BN, Humphris G, Annet H, et al. Rapid appraisal in an urban setting: an example from the developed world. Soc Sci Med 1991; 32: 909–15.

    Article  PubMed  CAS  Google Scholar 

  14. Pharmaceutical Education Program. The management of hypertension: a consensus statement. Med J Aust 1994; 160: S1–S16.

    Google Scholar 

  15. Conner M, Sparks P. The theory of planned behaviour and health behaviours. In: Conner M, Norman P, editors. Predicting health behaviour. Buckingham: Open University Press, 1996: 121–62.

    Google Scholar 

  16. Fogarty JS. Reactance theory and patient non-compliance. Soc Sci Med 1997; 45: 1277–88.

    Article  PubMed  CAS  Google Scholar 

  17. Sheeran P, Abraham C. The health belief model. In: Conner M, Norman P, editors. Predicting health behaviour. Buckingham: Open University Press, 1996: 23–61.

    Google Scholar 

  18. Hawe P, Degeling D, Hall J. Evaluating health promotion: a health worker’s guide. Sydney (NSW): Maclennan and Petty, 1990.

    Google Scholar 

  19. Gribich C. Qualitative research in health: an introduction. Sydney (NSW): Allen and Unwin, 1999.

    Google Scholar 

  20. Murray SA. Experiences with ‘rapid appraisal’ in primary care: involving the public in assessing health needs, orientating staff, and educating medical students. BMJ 1999; 318: 440–4.

    Article  PubMed  CAS  Google Scholar 

  21. Montgomery AA, Fahey T. A systematic review of the use of computers in the management of hypertension. J Epidemiol Community Health 1998; 52: 520–5.

    Article  PubMed  CAS  Google Scholar 

  22. Children’s Health Development Foundation, South Australia. Deakin University. The Australian Guide to Healthy Eating: summary information [brochure]. Canberra (ACT): Commonwealth Department of Health and Family Services, 1998.

  23. University of Western Sydney, Centre for Health Promotion and Research. National Physical Activity Guidelines for Australians [brochure]. Canberra (ACT): Commonwealth Department of Health and Aged Care, 1999.

    Google Scholar 

  24. Barwon Health. Relaxation: who needs it [brochure]. South Geelong: Barwon Health Community and Mental Health, 2000.

    Google Scholar 

  25. Drug and Alcohol Services Council. Standard drinks. Alcohol go easy [information card]. South Australia: Government of South Australia, 2000.

  26. South Australian Smoking and Health Project. Quit because you can [booklet]. Canberra (ACT): Commonwealth Department of Health and Family Services, 1997.

  27. Ebrahim S, & Davey-Smith G. Systematic review of randomised controlled trials of multiple risk factor interventions for preventing coronary heart disease. BMJ 1997; 314: 1666–74.

    Article  PubMed  CAS  Google Scholar 

  28. Toop L, Richards D. Preventing cardiovascular disease in primary care. BMJ 2001; 323: 246–7.

    Article  PubMed  CAS  Google Scholar 

  29. Kannel WB, Neaton JD, Wentworth D, et al. Overall and coronary heart disease mortality rates in relation to major risk factors in 325,348 men screened for the MRFIT. Multiple Risk Factor Intervention Trial. Am Heart J 1986; 112:825–36.

    Article  PubMed  CAS  Google Scholar 

  30. National Heart Foundation of Australia. Risk Factor Prevalence Study. (No. 3) Canberra: National Heart Foundation of Australia and Australian Institute of Health, 1989.

  31. Annett H, Rifkin SB. Guidelines for rapid participatory appraisal to assess community health needs. Geneva: World Health Organisation, 1995.

    Google Scholar 

  32. Department of Health, Flinders University, and the South Australian Community Health Research Unit. Improving health services through consumer participation: a resource guide for organisations. Canberra (ACT): Commonwealth Department of Health and Aged Care, 2000.

  33. General Practice Computing Group, Commonwealth Department of Health and Aged Care. Strategic framework: general practice information management and technology. Canberra (ACT): Commonwealth Department of Health and Aged Care, 1999.

    Google Scholar 

  34. Kaplan S, Greenfield S, Ware JE. Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Med Care 1989; 27: S110–27.

    Article  PubMed  CAS  Google Scholar 

  35. Wilson JMG, Jungner G. Principles and practice of screening for disease. Geneva: World Health Organisation, 1968. Public health papers No. 34.

    Google Scholar 

  36. Academy of Managed Care Pharmacy. Continuing series of concepts in managed care pharmacy. Disease state management/health management [online]. Available from URL: http://www.amcp.org/public/pubs/concepts/ [Accessed 2001 Mar 16].

  37. Greenhalgh T, Herxheimer A, Isaacs AJ, et al. Commercial partnerships in chronic disease management: proceeding with caution. BMJ 2000; 320: 566–8.

    Article  PubMed  CAS  Google Scholar 

  38. Montgomery AA, Fahey T, Peters TJ, et al. Evaluation of computer-based clinical decision support system and risk chart for management of hypertension in primary care: randomised controlled trial. BMJ 2000; 320: 686–90.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

Funding sources: AstraZeneca Pty Ltd, Aventis Pharma Pty Ltd, Bayer Australia Ltd, Pfizer Pty Ltd. The views expressed in this paper are those of the authors. All data and calculations used in the risk assessment component of the ADAGE CD-Rom were supplied by the Department of Epidemiology and Preventive Medicine, Monash University, Australia. The ADAGE CD-Rom was produced by Foundation Studios, Adelaide, Australia. Sponsor representatives on the ADAGE Management Committee are: Ms Alison Van Nooten, Clinical Projects Manager, AstraZeneca Pty Ltd; Dr Christine Smith, Health Outcomes Stream Manager, Pfizer Pty Ltd; Ms Susan Hopkins, Medical Manager, Aventis Pharma Pty Ltd; Dr Jeff Hassall, Medical Director, Bayer Australia Ltd. The authors also wish to thank all of the project informants, Dr Greg Pearce, the organizations who generously agreed to the use of their materials, and our reviewers for their constructive criticism.

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Authors and Affiliations

  1. Departments of General Practice and Psychology, University of Adelaide, North Tce, Adelaide, 5005, Australia

    Deborah A. Turnbull (Associate Professor)

  2. Department of General Practice, University of Adelaide, Adelaide, South Australia, Australia

    Helen Mensforth, Justin J. Beilby, John E. Marley & Farooq Qureshi

  3. Department of Clinical and Experimental Pharmacology, University of Adelaide, for the ADAGE Project Management Committee, University of Adelaide, Adelaide, South Australia, Australia

    Anne L. Tonkin

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  1. Deborah A. Turnbull
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  2. Helen Mensforth
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  3. Justin J. Beilby
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  5. Farooq Qureshi
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Correspondence to Deborah A. Turnbull.

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Turnbull, D.A., Mensforth, H., Beilby, J.J. et al. An Empirical Model for the Development of Disease Management Programs in General Practice. Dis-Manage-Health-Outcomes 10, 723–729 (2002). https://doi.org/10.2165/00115677-200210110-00006

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