Pay for performance program reduces treatment needed diabetic retinopathy - a nationwide matched cohort study in Taiwan

Sheu, Shwu Jiuan; Lin, Wen Liang; Yang, Yea Huei Kao; Hwu, Chi Min; Cheng, Ching Lan

doi:10.1186/s12913-018-3454-6

Cited by 6 publications

(4 citation statements)

References 24 publications

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“…But the report showed a low adherence to follow-up appointments in a public clinic with low cost and high accessibility in USA 13 . In Taiwan, National Health Insurance offers low cost and high accessibility of eye care compared to the rest of the world, but the regular follow-up rate is still low 14 . Compared to age-related macular degeneration (AMD), diabetic macular edema (DME) patients have worse compliance and adherence to treatment.…”

Section: Discussionmentioning

confidence: 99%

Importance of medication adherence in treatment needed diabetic retinopathy

Kao

Hsieh

Lee

et al. 2021

Sci Rep

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We aim to investigate the role of medication adherence history in treatment needed diabetic retinopathy (TNDR). We conducted a retrospective nested case–control study using 3 population-based databases in Taiwan. The major one was the 2-million-sample longitudinal health and welfare population-based database from 1997 to 2017, a nationally representative random sample of National Health Insurance Administration enrolled beneficiaries in 2010 (LHID2010). The national death registry and national cancer registry were also checked to verify the information. The outcome was defined as the TNDR. The Medication possession ratio (MPR) was defined as the ratio of total days of diabetes mellitus (DM) medication supply divided by total observation days. MPR ≥ 80% was proposed as good medication adherence. The association of MPR and the TNDR was analyzed. Other potential confounders and MPR ratio were also evaluated. A total of (n = 44,628) patients were enrolled. Younger aged, male sex and patients with less chronic illness complexity or less diabetes complication severity tend to have poorer medication adherence. Those with severe comorbidity or participating pay-for-performance program (P4P) revealed better adherence. No matter what the characteristics are, patients with good MPR showed a significantly lower likelihood of leading to TNDR after adjustment with other factors. The protection effect was consistent for up to 5 years. Good medication adherence significantly prevents treatment needed diabetic retinopathy. Hence, it is important to promote DM medication adherence to prevent risks of diabetic retinopathy progression, especially those who opt to have low medication adherence.

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Section: Discussionmentioning

confidence: 99%

Importance of medication adherence in treatment needed diabetic retinopathy

Kao

Hsieh

Lee

et al. 2021

Sci Rep

Self Cite

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“…Furthermore, the patients maintaining a good relationship with their healthcare provider(s), as shown by higher COC values, and those undergoing regular kidney or CV tests, also experienced a lower risk of retinopathy. A previous study similarly reported that participation in a P4P program improved the care of patients with diabetes through teamwork, provided they followed the clinical guidelines under the payment scheme 38 . Furthermore, chronic diseases require long-term care, and patients with type 2 diabetes benefit from a stable physician-patient relationship (in the high COC group) based on trust or from an integrated care team that can collaborate with other professionals to provide treatment in certain areas, such as dietary guidance and exercise coaching.…”

Section: Discussionmentioning

confidence: 99%

Synergy between the pay‐for‐performance scheme and better physician–patient relationship might reduce the risk of retinopathy in patients with type 2 diabetes

Chiou

Liao

Huang

et al. 2020

J of Diabetes Invest

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Aims/Introduction: This study investigated whether participation by patients with type 2 diabetes in Taiwan's pay-for-performance (P4P) program and maintaining good continuity of care (COC) with their healthcare provider reduced the likelihood of future complications, such as retinopathy. Materials and Methods: The analysis used longitudinal panel data for newly diagnosed type 2 diabetes from the National Health Insurance claims database in Taiwan. COC was measured annually from 2003 to 2013, and was used to allocate the patients to low, medium and high groups. Cox regression analysis was used with time-dependent (time-varying) covariates in a reduced model (with only P4P or COC), and the full model was adjusted with other covariates. Results: Despite the same significant effects of treatment at primary care, the Diabetes Complications Severity Index scores were significantly associated with the development of retinopathy. After adjusting for these, the hazard ratios for developing retinopathy among P4P participants in the low, medium and high COC groups were 0.594 (95% confidence interval [CI] 0.398-0.898, P = 0.012), 0.676 (95% CI 0.520-0.867, P = 0.0026) and 0.802 (95% CI 0.603-1.030, P = 0.1062), respectively. Thus, patients with low or median COC who participated in the P4P program had a significantly lower risk of retinopathy than those who did not. Conclusions: Diabetes care requires a long-term relationship between patients and their care providers. Besides encouraging patients to participate in P4P programs, health authorities should provide more incentives for providers or patients to regularly survey patients' lipid profiles and glucose levels, and reward the better interpersonal relationship to prevent retinopathy.

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“…Diabetes mellitus (DM) is a prevalent disease with significant comorbidities that not only affect the eyes but also cause cardiovascular disease, nephropathy, and neuropathy. Diabetic retinopathy (DR) affects an estimated one in three people with DM and may result in severe visual impairment [1]. Diabetic macular edema (DME), a common complication of DR, is pathologically linked to the disruption of the blood-retinal barrier [2].…”

Section: Introductionmentioning

confidence: 99%

Changes of Estimated Glomerular Filtration Rate and Glycated Hemoglobin A1c in Diabetic Macular Edema Patients Treated by Ranibizumab and Aflibercept in the Tertiary Referral Hospital

Tien

Lin

et al. 2022

Medicina

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Background and Objectives: Intravitreal injections (IVI) of vascular endothelial growth factor (VEGF) inhibitors are guideline-indicated treatments for diabetic macular edema (DME). However, some recent data have suggested that IVI VEGF inhibitors might, through systemic absorption, lead to a reduction in renal function. Our study aims to compare changes in glycated hemoglobin A1c (HbA1c) and estimated glomerular filtration rate (eGFR) between patients who received IVI ranibizumab and aflibercept treatment and patients who have not received IVI treatments. Materials and Methods: There were 17,165 DME patients with documented ophthalmology visits in the China Medical University Hospital-Clinical Research Data Repository. Those with a history of ESRD or bevacizumab treatment history, and those with missing information on HbA1c or eGFR, were excluded. After matching by age (±2 years), gender, and the year of clinical visit, 154 patients with medical treatment (including ranibizumab and aflibercept) and 154 patients without medical treatment were included in the study. The difference between HbA1c and eGFR at baseline and 3 and 12 months after the index date between the two groups was assessed. Results: Mean HbA1c and eGFR decreased between baseline and 12 months after the index date in both groups (p < 0.05). Compared with the non-treatment group, the treatment group had significantly lower HbA1c 3 and 12 months after the index date. There was no significant difference in eGFR between the two groups. In the generalized estimating equations (GEE) model, HbA1c in the treatment group was lower than the non-treatment group (−0.44%, 95% CI = −0.75, −0.14), but eGFR was similar after adjusting for age, gender, and index-year. HbA1c and eGFR decreased with the time in the adjusted GEE model (p < 0.0001) in both groups. Conclusions: This study showed that eGFR decreased with age and time and was not related to IVI anti-VEGF treatments in our tertiary referral hospital. IVI anti-VEGF therapy was also associated with better HbA1c control. It is suggested that DME patients can receive intravitreal VEGF inhibitors without inducing more renal impairment.

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Pay for performance program reduces treatment needed diabetic retinopathy - a nationwide matched cohort study in Taiwan

Cited by 6 publications

References 24 publications

Importance of medication adherence in treatment needed diabetic retinopathy

Importance of medication adherence in treatment needed diabetic retinopathy

Synergy between the pay‐for‐performance scheme and better physician–patient relationship might reduce the risk of retinopathy in patients with type 2 diabetes

Changes of Estimated Glomerular Filtration Rate and Glycated Hemoglobin A1c in Diabetic Macular Edema Patients Treated by Ranibizumab and Aflibercept in the Tertiary Referral Hospital

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