[Structured XXXX and an improvement in private health care lead to a better quality of @entity6 care. JEVIN, a population-based trial 1989/90 up to 1999/2000].

@entity1 @entity413 @entity6 @entity34
AIMS AND HYPOTHESES: JEVIN ( Jena's St. Vincent Trial) is a prospective, 10-year follow-up, population-based survey of all insulin-treated @entity1 with type 1 and @entity6 aged 16-60 years and living in the city of Jena (100,000 inhabitants), Thuringia. It aims to show the effects of recent changes in the health care system and new treatment strategies. During the period from 1989/90 to 1994/95, the health care system was decentralized. There has been an broad implementation of postgraduate educational courses for primary care physicians, of structured @entity34 ( @entity34 ), of intensified insulin therapy, and blood @entity413 self-monitoring for all @entity1 . @entity1 AND METHODS: 190 @entity1 (83% of the target population), 244 @entity1 (90%) and 261 @entity1 (90%) were studied in 1989/90, 1994/95 and 1999/2000, respectively. RESULTS: Up to 1994/95, the relative HbA(1c) (HbA(1c)/mean normal) of @entity1 with type 1 @entity6 increased (1994/95: 1.65 +/- 0.35 vs. 1989/90: 1.52 +/- 0.31; p = 0.002). For @entity1 with @entity6 it remained constant (1.75 +/- 0.4 vs. 1.78 +/- 0.31; p = 0.669). During the period from 1994/95 to 1999/2000, there was a substantial improvement in the relative HbA(1c) of both, @entity1 with type 1 (1.48 +/- 0.3; p < 0.0001), and type 2 @entity6 (1.47 +/- 0.25; p < 0.0001). Up to 1999/2000, 87.7% of the @entity1 with type 1 (1989/90: 0%, 1994/95: 73.2%) and 96.6% of the @entity1 with type 2 @entity6 (1989/90: 0%, 1994/95: 89.7%) participated in TTPs. Similarly, the percentage of @entity1 with intensified insulin therapy (type 1/2: 1989/90: 5.3%/3.4%, 1994/95: 80.3%/30.8%, 1999/2000: 94.7%/48.3%) and the frequency of weekly blood @entity413 self-monitoring (type 1/2: 1989/90: 1 [0-28]/0 [0-21], 1994/95: 25 [0-49]/14 [0-35], 1999/2000: 28 [0-70]/21 [0-46]) increased. Moreover, there was a drastic improvement in private health care: up to 1999/2000, about 90% of all the @entity1 studied were treated by primary care physicians who took part in postgraduate educational courses. CONCLUSIONS: During the past decade, there has been a substantial improvement in the quality of @entity6 control. The broad implementation of structured TTPs, intensified insulin therapy, and blood @entity413 self-monitoring for @entity1 with type 1 and 2 @entity6 seem to be the major cornerstones for the improved quality of @entity6 care. However, the impressive improvement in the quality of @entity6 care in @entity1 with @entity6 seems not to be related mainly to an increase (about 10% vs. 20% in type 1 @entity6 ) in the number of @entity1 under specialist care, but rather to an improvement in the quality of @entity6 therapy administered by private health care physicians.
