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Patients with chronic heart failure have complex care needs which can be addressed by case management interventions. Monitoring lists for heart failure were developed and tested as part of a trial evaluating primary care-based case management of patients with heart failure (HICMan).Design and characteristics of the monitoring lists used during the HICMan trial are described in order to evaluate technical feasibility and time expenditure. In a secondary analysis of data from the HICMan trial descriptive statistics were used.Two checklists were developed on the basis of evidence-based guidelines to regularly monitor heart failure patients by phone and home visits. These checklists contain questions about heart failure symptoms and signs (precursors) of clinical deterioration. Ninety-seven heart failure patients (64 NYHA class I/II, 33 NYHA class III) were monitored for 12 months. Eighteen critical incidents like acute angina pectoris or acute dyspnoea occurred during the study, two of them leading to immediate hospital admissions. Patients with NYHA class III had significantly more potentially clinically relevant incidents than patients with NYHA class I/II. Mean [SD, range] time expenditure for telephone monitoring was 10min [± 5min, 2 to 38min], for home visits 53min [± 13min, 18 to 90min]. Both monitoring lists appeared to be plausible and feasible tools for the primary care-based case management of heart failure patients.

In Germany, primary healthcare for patients with chronic diseases needs to be improved. Taking the example of depression, congestive heart failure, diabetes and diseases of the musculoskeletal system we analyzed to which extent the 'Chronic Care Model' allows for improvements.Diagnosis-specific health assessment; adaptation of the 'Chronic Care Model' to the German healthcare system; peer reviewed discussions of the potentials for improving primary care of the chronically ill. RESULTS/DISCUSSION OF THE HEALTHCARE SITUATION: 1) Diagnosis and therapy of chronic diseases comply insufficiently with the evidence. 2) Patients are too passive and/or receive only little effective support. 3) Treatments are often uncoordinated and fragmented. 4) The follow-up of treatment results is often neglected. 5) Approaches to indicated diseases are promising.The'Chronic Care Model' could improve chronic care in Germany. Disease Management Programs (DMP) should amend multimorbidity and individual healthcare and/or facilitate implementation in general practice.

Chronic diseases and multimorbidity are becoming a fundamental challenge for primary care which already requires a very high input of resources. Due to their broad range and continuity, general practices play a major role, but are poorly prepared to succeed in the structured healthcare of chronically ill patients. The reality of care in everyday practice is primarily characterized by the 'tyranny of the urgent', and such a reaction to acute problems leads to noticeable deficits in permanent care. Part one of a two-part article series asks to what extent demographic changes and medical progress are responsible for this development. Meanwhile, a large quantity of empirical evidence indicates that results improve when case management is implemented for chronically ill patients. Though disease management programs are being increasingly established in Germany, many general practices are only poorly prepared for their tangible implementation in everyday routine. The comparison of two case studies shows how the primary care of chronically ill patients might look like in the future. On the basis of both scientific evidence and the globally acknowledged 'Chronic Care Model', part two of the article looks at sustainable strategies and special tools which allow for an adequate care of chronically ill patients in general practice.

In 2002 the German "Curriculum Evidence-based Medicine" was made available by the Agency for Quality in Medicine and the German Network for Evidence-based Medicine. Its primary aim was to train practising medical doctors. We adapted the curriculum for participants of a postgraduate Master of Public Health course and a course for medical students. The two groups differ from the main target group regarding both their baseline knowledge and the objectives of their respective training courses. Here we report how the curriculum was adapted. The curriculum was adjusted in several ways: The postgraduate course focused on case studies with public health relevance. Beyond the obligatory modules, the focus was on training skills in searching and assessing secondary and tertiary evidence like systematic reviews or health technology assessments. In addition, the health policy context for evidence based medicine in Germany was analysed. In the course that aimed at medical students we included the module "Critical Appraisal of a Survey". At the beginning of each case study, the frequency and relevance of the health problems were elaborated. Apart from case studies on therapeutic interventions we also presented studies on diagnosis, prognosis and screening to demonstrate that evidence-based clinical decision making is feasible for the whole spectrum of questions arising from patient care. The curriculum proved to be adaptive to the needs of heterogeneous groups of participants. In this article we provide a detailed list of practical recommendations for courses for students of Public Health and Medicine.