Disease management in the Dutch context

This book explores the extent to which ten characteristics of the concept of disease management are advisable in the long-term for certain types of patient care in the Netherlands. The care in mind for this concept covers certain patient populations as well as a number of health problems. For this purpose, the authors have taken as their starting point the following definition of disease management: the programmatical and systematic approach of specific diseases and health problems by using the management instruments that aim at the advancement of quality and efficiency. This definition is based on the literature study that was carried out by C. Spreeuwenberg for his research into the material covered in the first chapter. 
The ten characteristics of disease management that were derived from the general literature by the aforementioned author are as follows: 
1. relates to one health problem and is aimed at clearly-defined patient populations and sub-populations 
2. methodological education and the advancement of self-management 
3. orientation on the integration of the various parts of the care processes including preventive interventions 
4. disease management protocols that are based on evidence-based diagnostics and treatment 
5. classification of patients in clinical pathways based on sub-characteristics 
6. substitution of care from physicians to nurses 
7. use of information and communication technology 
8. focus on the use of a range of management instruments such as benchmarking and feedback 
9. large-scale and a robust organizational structure 
10. direction and funding coming from a central point 
The characteristics are thus classified according to patient care (characteristics 1 through 5) organization of the patient care (characteristics 6 and 7) and the management of patient care (characteristics 8 through 10). 
The patient populations that were studied were those of cystic fibrosis (chapter 2), diabetes (chapter 3), depression (chapter 4), heart failure (chapter 5), and palliative patients (chapter 6). The choice for these patient populations was made by representatives of the Dutch Council for the Chronically Ill and Disabled (CG Raad). The idea was to cover a wide range of disorders affecting the young (cystic fibrosis) to the old (heart failure, palliative care) to psychiatric (depression) and somatic illnesses (other patient populations) and on the common disorders (diabetes, heart failure) and less common disorders (cystic fibrosis, palliative care). Authors were sought with a wide range of expertise on the development of integrated care for the patient population concerned. They used knowledge from five sources: 1) their own personal experience and expertise (see author information in appendix II), 2) recent published articles covering the period 1999-2004, specifically searched through Pubmed and Google; 3) the travel reports of Marianne Acampo who visited one location per patient group in the United States, 4) expert meetings in the spring of 2004 whereby leading care professionals for each patient population, project leaders and policy-makers in the area of integrated care in the Netherlands were present, and, 5) individual analytical and judgemental skills. On the basis of this last-mentioned factor, the authors reached their conclusions on whether or not disease management should eventually be introduced in the Netherlands for their respective patient populations. In short, their answer was: Yes, disease management is a desirable concept but only if…

The core of the book comprises chapters on each of the five diseases and patient groups. Context for these chapters is provided by a summary of the literature on disease management that identifies ten characteristics for an ideal disease management programme. These characteristics are applied in the main chapters of the book, and the results are synthesised in the concluding chapter. The authors conclude that it is advisable to apply the American concept of disease management in the Netherlands, albeit in a way that is relevant to the Dutch context.
In reviewing this book, it is important to emphasise that it brings together existing evidence and the views of experts, rather than presenting original empirical research. Also, it leans heavily on the review of the literature on disease management carried out by Spreeuwenberg and presented in the first chapter. It is here that the ten characteristics of disease management are outlined, including a focus on clearly defined patient populations, the use of patient education and self-management, and the reallocation of tasks from physicians to nurses.
In the main chapters of the book, the authors apply these ten characteristics with varying degrees of rigour. In most of the chapters, the characteristics are used more as an afterthought than an organising framework, with the consequence that the chapters vary widely in their approach. For this reviewer, their main value was the information they provided about current arrangements in the Netherlands for the diseases and patient groups included in the analysis.
The final chapter provides a helpful summary of the principal issues covered in the book, and is a useful starting point for readers interested in the general theme of disease management rather than the detail of particular conditions. The chapter would have been even more helpful if there had been greater consistency with the first chapter in the discussion of the ten characteristics of disease management. The list of these characteristics set out by Spreeuwenberg on p.16 is rendered differently and therefore, confusingly by Schrijvers et al. on p. 122, a weakness that might have been avoided with tighter editing.
Although the authors conclude that it is advisable to apply the American concept of disease management in the Netherlands, the justification for this conclusion was not clear to this reviewer. In the United States, disease management has emerged as an attempted solution to the problems of that country's fragmented non-system. In European countries, especially countries like the Netherlands and the United Kingdom in which primary care is well developed, a case can be made using primary care as the focus for managing chronic diseases, rather than using organisations established to deal with narrowly defined patient populations.
The major challenge in European countries is how to ensure that primary care is effectively integrated with secondary care and social care to better meet the needs of people with chronic diseases. This challenge assumes even greater importance in a context in which those in the greatest need do not have single diseases but are often older people with multiple and complex conditions. It would have been interesting if the authors had explored this issue in more detail, drawing on the experience of integrated delivery systems such as Kaiser Permanente as well as the evidence on disease management. This book can be recommended to readers from both academic and professional backgrounds wanting to gain an understanding of the management of chronic diseases in the Netherlands. Its main limitation is the use of a narrow lens with which to explore chronic disease management and the inconsistent application of this lens. Also, the authors could have done more to justify their conclusions, and to explore ways in which the current Dutch approach may be preferable to an American invention that offers a solution to a problem that European countries do not have.
I would give the book 2 stars out of 5.