Effects of Patient Empowerment Programme (PEP) on Clinical Outcomes and Health Service Utilization in Type 2 Diabetes Mellitus in Primary Care: An Observational Matched Cohort Study

Abstract

BackgroundTo evaluate the effects of a large population-based patient empowerment programme (PEP) on clinical outcomes and health service utilization rates in type 2 diabetes mellitus (T2DM) patients in the primary care setting.Research Design and SubjectsA stratified random sample of 1,141 patients with T2DM enrolled to PEP between March and September 2010 were selected from general outpatient clinics (GOPC) across Hong Kong and compared with an equal number of T2DM patients who had not participated in the PEP (non-PEP group) matched by age, sex and HbA1C level group.MeasuresClinical outcomes of HbA1c, SBP, DBP and LDL-C levels, and health service utilization rates including numbers of visits to GOPC, specialist outpatient clinics (SOPC), emergency department (ED) and inpatient admissions, were measured at baseline and at 12-month post-recruitment. The effects of PEP on clinical outcomes and health service utilization rates were assessed by the difference-in-difference estimation, using the generalized estimating equation models.ResultsCompared with non-PEP group, PEP group achieved additional improvements in clinical outcomes over the 12-month period. A significantly greater percentage of patients in the PEP group attained HbA1C≤7% or LDL-C≤2.6 mmol/L at 12-month follow-up compared with the non-PEP group. PEP group had a mean 0.813 fewer GOPC visits in comparison with the non-PEP group.ConclusionsPEP was effective in improving the clinical outcomes and reduced the general outpatient clinic utilization rate over a 12-month period. Empowering T2DM patients on self-management of their disease can enhance the quality of diabetes care in primary care.Trial RegistrationClinicalTrials.gov NCT01935349

Five-Year Cost-effectiveness of the Multidisciplinary Risk Assessment and Management Programme–Diabetes Mellitus (RAMP-DM)

“…First, the multidisciplinary RAMP-DM team provided more education, including education on disease knowledge, self-care, and lifestyle, through nurse intervention, the Patient Empowerment Programme (PEP) (22), the smoking cessation, and a dietitian. Diabetes self-management education has been proved to prevent or delay the complication of diabetes (23-27); thus, the American Diabetes Association recommended standards for diabetes self-management education, which requires a multidisciplinary team, including physicians, nurses, a dietitian, and pharmacists, to provide structured, individual, and ongoing education to patients (28).…”

Complicações e o tempo de diagnóstico do diabetes mellitus na atenção primária

“…(14) In addition to the properly use of the medication, the control of diabetes and the prevention of its early onset, there is a need for changes in lifestyle that mostly involves eating habits and physical activity, in addition to other factors, such as stress, self-esteem, psychological attitudes and empowerment to self-care. (15) A compiled of five randomized controlled trials evaluated the effectiveness of interventions in lifestyle of Asian population without diabetes mellitus and in other six studies evaluated the effectiveness of drugs, including metformin, α-glycosidase and glitazone inhibitors. The results were satisfactory in the sense that lifestyle interventions (risk reduction of 29-71%) and metformin (risk reduction of 26-52%) appeared to be as effective, if not more effective, in Asian populations with the reduction in the risk for developing diabetes mellitus.…”

Patient Empowerment Programme (PEP) and Risk of Microvascular Diseases Among Patients With Type 2 Diabetes in Primary Care: A Population-Based Propensity-Matched Cohort Study

“…Although the explicit changes in glycemic control after structured education have been well established, limited evidence (3) has demonstrated the effect of structured education on diabetesrelated complications. Recent studies (4,5) underwent an investigation of the effects on glycemic control and incidence of cardiovascular complication in a structured diabetes education program, Patient Empowerment Programme (PEP), versus the usual clinical practice in a Hong Kong primary care setting. Detailed description of PEP setting and mode of education delivery have been reported previously (4,5).…”

“…Recent studies (4,5) underwent an investigation of the effects on glycemic control and incidence of cardiovascular complication in a structured diabetes education program, Patient Empowerment Programme (PEP), versus the usual clinical practice in a Hong Kong primary care setting. Detailed description of PEP setting and mode of education delivery have been reported previously (4,5). However, whether the structured education would be associated with a lower risk of diabetic retinopathy, nephropathy, neuropathy, and composite microvascular complication events remains questionable.…”