Intended for healthcare professionals

Education And Debate

Adoption of disease management model for diabetes in region of Maastricht

BMJ 2001; 323 doi: (Published 27 October 2001) Cite this as: BMJ 2001;323:983
  1. H J M Vrijhoef, research fellowa (,
  2. C Spreeuwenberg, professora,
  3. I M J G Eijkelberg, research fellowb,
  4. B H R Wolffenbuttel, associate professorc,
  5. G G van Merode, associate professorb
  1. a Department of Health Care Studies, Faculty of Health Sciences, University of Maastricht, PO Box 616, 6200 MD Maastricht, Netherlands
  2. b Department of Health Organisation, Policy and Economics, Faculty of Health Sciences, University of Maastricht, PO Box 616, 6200 MD Maastricht, Netherlands
  3. c Department of Endocrinology, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, Netherlands
  1. Correspondence to: H J M Vrijhoef
  • Accepted 5 September 2001

Chronic diseases and associated conditions will always pose a challenge to healthcare systems. New healthcare models are being introduced in Western countries in response to a set of problems that are evident to some degree in all health services—for example, uncoordinated arrangements for delivering care, bias towards acute treatment, neglect of preventive care, and inappropriate treatment.1 These models take account of the pressure on quality and costs of chronic care and originate from the overlapping approaches of integrated care (United States) and shared care (western Europe). 2 3 In the Netherlands, shared care models have acted as a precursor of the recently introduced concept of disease management. Although several disease management initiatives are emerging, the model is not being adopted as fast as might be expected from the benefits that are claimed to result from it.4 In this article we describe the process of moving from a shared care model to a disease management model by considering recent developments in diabetes care in the region of Maastricht. We also describe the use of health technology assessment to evaluate the model.

Summary points

The concepts of integrated care and shared care can be regarded, in the Netherlands at least, as the precursor of disease management

Implementation of a shared care model for diabetes in the region of Maastricht ensured that necessary conditions were met for a disease management model

Widespread use of disease management models is hampered by lack of evidence

Evidence from health technology assessment is necessary to justify large scale use of disease management models but will not be sufficient by itself

Shared diabetes care in Maastricht region

Shared care for patients with stable diabetes mellitus type 2 who were receiving care from an endocrinologist in an outpatient clinic was implemented in the region of Maastricht in 1997. Two changes were made from usual care: …

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