In 11 'farrow-to-finish' outdoor or indoor production units, blood samples from late pregnant gilts were tested by indirect immunofluorescence antibody (IFA) serum assay for Lawsonia intracellularis. The offspring of positively tested gilts were tested at 2, 7, 12, 17, 22 and 27 weeks of age for seroprevalence of Lawsonia intracellularis. All offspring of IFA positive gilts were seronegative at 2 and 7 weeks of age. At 12 weeks of age 81.0% of indoor and 51.0% of outdoor pigs were tested positive. While at 17 weeks of age 82.5% of indoor-raised pigs showed seropositivity, in outdoor units the seropositivity declined to 31.3%. At weeks 22 and 27 indoor-raised pigs still showed marked seropositivity (17.7% and 11.5%) but their outdoor-raised counterparts revealed declining values (7.4% and 0%).
Objective. This study investigates whether introducing targeted CME into a regular feedback system being part of a disease management programme (DMP) will improve prescription behaviour, and if yes, how long it will take to demonstrate this effect and what could be the magnitude of such an effect. Methods. From the database of the DMP coronary artery disease (CAD) in the two German regions of North Rhine (NR) and Westphalia Lippe (WL), respectively, all patients with heart failure in New York Heart Association (NYHA) class II and III were extracted. Prescription of combination therapy (ACE inhibitor, ACE-I, and beta blocker, BB), as recommended by the guidelines, was prospectively monitored for 6 years after this topic was addressed in a series of accredited CME modules. These modules were part of extended feedback reports for NR physicians, while physicians in WL received basic feedback reports only. Data were analysed according to participants vs. non-participants in CME vs. control group (WL). Results. The largest increase was observed with regard to the additional prescription of an ACE-I in patients who only received a BB at baseline. BB prescription rates increased to a lesser extent. But for both drugs, prescription rates did not reach their maximum even at the end of the 6 years' observation period. Significant differences in prescription rates in favour of patients of CME participants could only be demonstrated after 3 years from the first CME article. Conclusions. The DMP CAD has to be considered as a multifaceted intervention which significantly changes prescription behaviour. Combination of the DMP with a further multifaceted intervention (print CME) added only little to this effect. The time course of change makes it difficult exclusively to relate the observed changes in prescription rates to the CME intervention.
Physicians always aim to improve their patients' health. CME should be designed not only to provide knowledge transfer, but also to influence clinical decision-making and to close performance gaps. In aretrospective study we analysed prescription rates for APT in 254,932 CAD patients (male: 64.4%), treated in atotal of 3,405 practices in 2019 in aDMP in the region of North Rhine, Germany. Analyses were run for the whole study population stratified by sex as well as for subgroups of patients suffering from myocardial infarction/acute coronary syndrome, or who have been treated with percutaneous coronary intervention or bypass surgery. Patients mean age was 72.7 ± 11.2 years (mean ± 1SD), mean duration of DMP participation was 7.2 ± 4.7 years, and mean cumulative number of DMP visits was 27 ± 17. APT prescription rates were 85.0% in male and 78.8% in female CAD patients. In subgroups of male CAD patients APT prescription rates were between 89.7% and 92.8%, in the same subgroups of female CAD patients the corresponding rates were between 87.8% and 92.0%. Rates for amissing APT prescription per practice were between .0044% and .0062% for male and female CAD patients, respectively. Rates for amissing APT prescription per practice and DMP visit were .0002% for both sexes. These results suggest that a DMP can achieve high attainment rates for APT in CAD. To further improve attainment rates, consideration of absolute numbers of eligible patients per practice or physician is probably more appropriate than expression of performance as percentage values. This is especially true if attainment rates show substantial variations between subgroups, if subgroups show substantial variation in size, if attainment rates are already in the magnitude of 80% or higher, and if there are disparities in the evidence base underlying treatment recommendations related to subgroups.
Disease Management Programmes (DMPs) have been introduced by German Federal Government in 2002 to improve long-term care for patients with specific chronic diseases. Digitisation has been a requirement to reliably document patient data in DMPs. This report presents data from six DMPs in the German federal state of North Rhine-Westphalia. It demonstrates that high level long-term quality of care can be achieved and maintained. But beyond clinical purposes DMP data are also an invaluable source to supply content in CME.
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