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The comparison of cross-sectional indicators with sequential indicators to evaluate the intermediate outcomes of type 2 diabetic patients cared for by the family physician in a community hospital
Date Issued
2009
Date
2009
Author(s)
Huang, Hsin-Yang
Abstract
Background: Diabetes mellitus (DM) is one of the top ten causes of death in Taiwan. The medical care for DM patients is getting more and more depending on the cooperation of multidisciplinary teams, frequent health educations, and regular follow-up for complications. Few studies have been focused on the effectiveness of DM intervention programs executed by family physicians. In addition, studies in the literature evaluated the effectiveness of DM intervention programs using cross-sectional indicators. None of them evaluated the effectiveness of DM intervention programs using sequential indicators.bjectives: Cross-sectional indicators and sequential indicators were used to evaluate the effectiveness of structured care (SC) for type 2 DM patients in a community hospital in Taitung by family physicians as compared to those who received usual care (UC). ethods: This is a retrospective cohort study. Patients were recruited between October 1, 2007 and January 31, 2008. After patients’ consents were provided, the patients who were regularly followed up for three months or longer in the outpatient clinics of family medicine before recruitment were assigned to the SC group. Others were assigned to the UC group. All patients were followed up for one year after they were assigned to the SC group or the UC group. Bivariate analysis was performed to explore the association between an independent variable and the dependent variable using Chi-square test (or Fisher’s exact test) for dichotomous independent variables or Student’s t test for continuous independent variables. Multivariate logistic regression analysis was also performed to explore the associations between the independent variables of interest and the dependent variables.esults: One hundred and twenty patients were assigned to the SC group and 99 patients were assigned to the UC group.he accountability (process indicator of diabetic care) in SC group is significantly better compared with UC group: more patients (99.2%) in the SC group had annual foot exam than UC group(24.2%)(p-value <0.001); more patients (90%) in the SC group had annual dilated eye exam than UC group(55.6%)(p-value <0.001); more patients (43.3%) in the SC group ever received pneumococcal vaccination than UC group(21.2%)(p-value=0.001);more patients (100%) in the SC group had biannual check up of HbA1C than UC group(96%)(p-value=0.04) .hree cross-sectional indicators were used to compare the two groups before controlling for other confounding variables: more patients (53.3%) in the SC group reach the goal of LDL < 100mg/dL than the UC group (32.3%). (p-value = 0.002); more patients (32.5%) in the SC group reach the goal of HbA1C < 7% than the UC group (21.2%), though the difference is of borderline significance (p-value = 0.062); sixty (50%) participants in the SC group and 40 (40.4%) participants in the UC group reach the goal of SBP < 130 mmHg (p-value = 0.156). As demonstrated by sequential indicators defined as improved or being controlled: 72 (60%) participants in the SC group showed good sequential indicator of HbA1C, while only 42 (42.4%) in the UC group showed good sequential indicator of HbA1C (p-value = 0.010); no significant differences were found between the SC and UC group using sequential indicator of serum total cholesterol (p-value = 1.000) and SBP (p-value = 0.363). After controlling for other confounding variables using multivariate logistic regression analysis, the participants in the SC group were more likely to reach the goal of LDL < 100mg/dL than the participants in the UC group (O.R. = 2.58, 95% C.I. = 1.43 – 4.65, p-value = 0.002); no significant differences were shown between the two groups as indicated by cross-sectional indicator of SBP (O.R. = 1.61, 95% C.I. = 0.91 – 2.83, p-value = 0.101) and HbA1C (O.R. = 1.57, 95% C.I. = 0.75 – 3.29, p-value = 0.235). Sequential indicator of HbA1C, serum total cholesterol (T-CHO), and SBP were used to evaluate the effectiveness of structured care after controlling for other confounding variables: significantly more participants in the SC group resulted in good sequential indicator of HbA1C than those in the UC group (O.R. = 3.35, 95% C.I. = 1.61 – 6.94, p-value = 0.001); no significant differences between the SC group and the UC group were found using the sequential indicator of T-CHO (O.R. = 1.41, 95% C.I. = 0.72 – 2.74, p-value = 0.318) and sequential indicator of SBP (O.R. = 0.93, 95% C.I. = 0.47 – 1.84, p-value = 0.839).igher proportion of participants(83.3%)in the SC group had better adherence, defined as medication possession rate (MPR) greater than 0.8, than those in the UC group(65.7%) (p-value = 0.003). SC group was significantly associated with good MPR as compared to the UC group after controlling for other confounding variables (O.R. = 2.27, 95% C.I. = 1.15 – 4.46, p-value = 0.017).onclusion: The structured care significantly has better accountability of process of diabetic care and improves the intermediate outcome of type 2 DM patients as indicated by sequential indicator of HbA1C, though the effect did not appear if cross-sectional indicator of HbA1C is used to evaluate the effectiveness of the program. Furthermore, MPR demonstrate that the structured care is significantly associated with better adherence.
Subjects
diabetes mellitus
sequential indicator
cross-sectional indicator
structured car
adherence
accountability
SDGs
Type
thesis
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