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Featured researches published by Birgit Fullerton.


BMC Health Services Research | 2013

Is Europe putting theory into practice? A qualitative study of the level of self-management support in chronic care management approaches

Arianne Elissen; Ellen Nolte; Cécile Knai; Matthias Brunn; Karine Chevreul; Annalijn Conklin; Isabelle Durand-Zaleski; Antje Erler; Maria Flamm; Anne Frølich; Birgit Fullerton; Ramune Jacobsen; Zuleika Saz-Parkinson; Antonio Sarría-Santamera; Andreas Sönnichsen; H.J.M. Vrijhoef

BackgroundSelf-management support is a key component of effective chronic care management, yet in practice appears to be the least implemented and most challenging. This study explores whether and how self-management support is integrated into chronic care approaches in 13 European countries. In addition, it investigates the level of and barriers to implementation of support strategies in health care practice.MethodsWe conducted a review among the 13 participating countries, based on a common data template informed by the Chronic Care Model. Key informants presented a sample of representative chronic care approaches and related self-management support strategies. The cross-country review was complemented by a Dutch case study of health professionals’ views on the implementation of self-management support in practice.ResultsSelf-management support for chronically ill patients remains relatively underdeveloped in Europe. Similarities between countries exist mostly in involved providers (nurses) and settings (primary care). Differences prevail in mode and format of support, and materials used. Support activities focus primarily on patients’ medical and behavioral management, and less on emotional management. According to Dutch providers, self-management support is not (yet) an integral part of daily practice; implementation is hampered by barriers related to, among others, funding, IT and medical culture.ConclusionsAlthough collaborative care for chronic conditions is becoming more important in European health systems, adequate self-management support for patients with chronic disease is far from accomplished in most countries. There is a need for better understanding of how we can encourage both patients and health care providers to engage in productive interactions in daily chronic care practice, which can improve health and social outcomes.


BMC Health Services Research | 2012

Predictors of dropout in the German disease management program for type 2 diabetes

Birgit Fullerton; Antje Erler; Boris Pöhlmann; Ferdinand M. Gerlach

BackgroundTo improve and assess the effectiveness of disease management programs (DMPs), it is critical to understand how many people drop out of disease management programs and why.MethodsWe used routine data provided by a statutory health insurance fund from the regions North Rhine, North Wurttemberg and Hesse. As part of the German DMP for type 2 diabetes, the insurance fund received regular documentation of all members participating in the program. We followed 10,989 patients who enrolled in the DMP between July 2004 and December 2005 until the end of 2007 to study how many patients dropped out of the program. Dropout was defined based on the discontinuation of program documentation on a particular patient, excluding situations in which the patient died or left the insurance fund. Predictors of dropout, assessed at the time of program enrolment, were explored using logistic regression analysis.Results5.5% of the patients dropped out of the disease management program within the observation period. Predictors of dropout at the time of enrolment were: region; retirement status; the number of secondary diseases; presence of a disabling secondary disease; doctors recommendations to stop smoking or to seek nutritional counselling; and the completion and outcome of the routine foot and eye exams. Different trends of dropout were observed among retired and employed patients: retired patients of old age, who possibly drop out of the program due to other health care priorities and employed people of younger age who have not yet developed many secondary diseases, but were recommended to change their lifestyle.ConclusionsOverall, dropout rates for the German disease management programs for type 2 diabetes were low compared to other studies. Factors assessed at the time of program enrolment were predictive of later dropout and should be further studied to provide information for future program improvements.


BMJ Open | 2016

Pilot study to test the feasibility of a trial design and complex intervention on PRIoritising MUltimedication in Multimorbidity in general practices (PRIMUMpilot)

Christiane Muth; Sebastian Harder; Lorenz Uhlmann; Justine Rochon; Birgit Fullerton; Corina Güthlin; Antje Erler; Martin Beyer; Marjan van den Akker; Rafael Perera; André Knottnerus; Jose M. Valderas; Ferdinand M. Gerlach; Walter E. Haefeli

Objective To improve medication appropriateness and adherence in elderly patients with multimorbidity, we developed a complex intervention involving general practitioners (GPs) and their healthcare assistants (HCA). In accordance with the Medical Research Council guidance on developing and evaluating complex interventions, we prepared for the main study by testing the feasibility of the intervention and study design in a cluster randomised pilot study. Setting 20 general practices in Hesse, Germany. Participants 100 cognitively intact patients ≥65 years with ≥3 chronic conditions, ≥5 chronic prescriptions and capable of participating in telephone interviews; 94 patients completed the study. Intervention The HCA conducted a checklist-based interview with patients on medication-related problems and reconciled their medications. Assisted by a computerised decision-support system (CDSS), the GPs discussed medication intake with patients and adjusted their medication regimens. The control group continued with usual care. Outcome measures Feasibility of the intervention and required time were assessed for GPs, HCAs and patients using mixed methods (questionnaires, interviews and case vignettes after completion of the study). The feasibility of the study was assessed concerning success of achieving recruitment targets, balancing cluster sizes and minimising drop-out rates. Exploratory outcomes included the medication appropriateness index (MAI), quality of life, functional status and adherence-related measures. MAI was evaluated blinded to group assignment, and intra-rater/inter-rater reliability was assessed for a subsample of prescriptions. Results 10 practices were randomised and analysed per group. GPs/HCAs were satisfied with the interventions despite the time required (35/45 min/patient). In case vignettes, GPs/HCAs needed help using the CDSS. The study made no patients feel uneasy. Intra-rater/inter-rater reliability for MAI was excellent. Inclusion criteria were challenging and potentially inadequate, and should therefore be adjusted. Outcome measures on pain, functionality and self-reported adherence were unfeasible due to frequent missing values, an incorrect manual or potentially invalid results. Conclusions Intervention and trial design were feasible. The pilot study revealed important limitations that influenced the design and conduct of the main study, thus highlighting the value of piloting complex interventions. Trial registration number ISRCTN99691973; Results.


International Journal of Care Coordination | 2014

Evaluating chronic disease management in real-world settings in six European countries: Lessons from the collaborative DISMEVAL project

Arianne Elissen; Ellen Nolte; Saba Hinrichs; Annalijn Conklin; John L. Adams; Benjamin Cadier; Karine Chevreul; Isabelle Durand-Zaleski; Antje Erler; Maria Flamm; Anne Frølich; Birgit Fullerton; Ramune Jacobsen; Cécile Knai; Zuleika Saz-Parkinson; Antonio Sarría-Santamera; Andreas Sönnichsen; H.J.M. Vrijhoef

Objective To describe the interventions, research methods and main findings of the international DISMEVAL project, in which the “real-world” impact of exemplary European disease management approaches was investigated in six countries using advanced analytic techniques. Design Across countries, the project captured a wide range of disease management strategies and settings; approaches to evaluation varied per country, but included, among others, difference-in-differences analysis and regression discontinuity analysis. Setting Austria, Denmark, France, Germany, The Netherlands, and Spain. Participants Health care providers and/or statutory insurance funds providing routine data from their disease management interventions, mostly retrospectively. Intervention(s) This study did not carry out an intervention but evaluated the impact of existing disease management interventions implemented in European care settings. Main outcome measure(s) Outcome measures were largely dependent on available routine data, but could concern health care structures, processes, and outcomes. Results Data covering 10 to 36 months were gathered concerning more than 154,000 patients with three conditions. The analyses demonstrated considerable positive effects of disease management on process quality (Austria, Germany), but no more than moderate improvements in intermediate health outcomes (Austria, France, Netherlands, Spain) or disease progression (Denmark) in intervention patients, where possible compared with a matched control group. Conclusions Assessing the “real-world” impact of chronic disease management remains a challenge. In settings where randomization is not possible and/or desirable, routine health care performance data can provide a valuable resource for practice-based evaluations using advanced analytic techniques.


Health Services Research | 2016

The Comparison of Matching Methods Using Different Measures of Balance: Benefits and Risks Exemplified within a Study to Evaluate the Effects of German Disease Management Programs on Long-Term Outcomes of Patients with Type 2 Diabetes.

Birgit Fullerton; Boris Pöhlmann; Robert Krohn; John L. Adams; Ferdinand M. Gerlach; Antje Erler

OBJECTIVE To present a case study on how to compare various matching methods applying different measures of balance and to point out some pitfalls involved in relying on such measures. DATA SOURCES Administrative claims data from a German statutory health insurance fund covering the years 2004-2008. STUDY DESIGN We applied three different covariance balance diagnostics to a choice of 12 different matching methods used to evaluate the effectiveness of the German disease management program for type 2 diabetes (DMPDM2). We further compared the effect estimates resulting from applying these different matching techniques in the evaluation of the DMPDM2. PRINCIPAL FINDINGS The choice of balance measure leads to different results on the performance of the applied matching methods. Exact matching methods performed well across all measures of balance, but resulted in the exclusion of many observations, leading to a change of the baseline characteristics of the study sample and also the effect estimate of the DMPDM2. All PS-based methods showed similar effect estimates. Applying a higher matching ratio and using a larger variable set generally resulted in better balance. Using a generalized boosted instead of a logistic regression model showed slightly better performance for balance diagnostics taking into account imbalances at higher moments. CONCLUSION Best practice should include the application of several matching methods and thorough balance diagnostics. Applying matching techniques can provide a useful preprocessing step to reveal areas of the data that lack common support. The use of different balance diagnostics can be helpful for the interpretation of different effect estimates found with different matching methods.


Cochrane Database of Systematic Reviews | 2014

Intensive glucose control versus conventional glucose control for type 1 diabetes mellitus

Birgit Fullerton; Klaus Jeitler; Mirjam Seitz; Karl Horvath; Andrea Berghold; Andrea Siebenhofer


Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen | 2011

Qualität Der Versorgung Chronisch Kranker in Deutschland

Birgit Fullerton; Ellen Nolte; Antje Erler


Cochrane Database of Systematic Reviews | 2016

Short-acting insulin analogues versus regular human insulin for adults with type 1 diabetes mellitus.

Birgit Fullerton; Andrea Siebenhofer; Klaus Jeitler; Karl Horvath; Thomas Semlitsch; Andrea Berghold; Johannes Plank; Thomas R. Pieber; Ferdinand M. Gerlach


Archive | 2012

Evaluating chronic disease management

Ellen Nolte; Annalijn Conklin; John L. Adams; Matthias Brunn; Benjamin Cadier; Karine Chevreul; Isabelle Durand-Zaleski; Arianne Elissen; Antje Erler; Maria Flamm; Anne Frølich; Birgit Fullerton; Ramune Jacobsen; Cécile Knai; Robert Krohn; Boris Pöhlmann; Zuleika Saz Parkinson; Antonio Sarria Santamera; Andreas Sönnichsen; H.J.M. Vrijhoef


Archive | 2014

the collaborative DISMEVAL project Evaluating chronic disease management in real-world settings in six European countries: Lessons from

Antonio Sarría-Santamera; Andreas Sönnichsen; Antje Erler; Maria Flamm; Anne Frølich; Birgit Fullerton; Ramune Jacobsen; Cécile Knai; Arianne Elissen; Ellen Nolte; Saba Hinrichs; John L. Adams; Benjamin Cadier; Karine Chevreul

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Antje Erler

Goethe University Frankfurt

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Maria Flamm

Danube University Krems

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Anne Frølich

University of Copenhagen

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