Effect of motivated physicians and elderly patients with hypertension or type 2 diabetes mellitus in prepared communities on health behaviours and outcomes

Effects of the Community-based Registration and Management for Hypertension and Type 2 Diabetes Mellitus Project (CRMHDP) on health behaviours and outcomes in South Korea

Hyunsung Kim1,2, Yaeji Lim1,3, Soon Young Lee1,4, Weon-Young Lee1,4

1 Department of Health Administration, College of Health and Welfare, Chung-Ang University, Seoul, Korea

2 Department of Preventive Medicine, Dongguk University Ilsan Hospital, Ilsan, Korea

3 Department of Health Services Administration, Seoul National University, Seoul, Korea

4 Clinical Trial Center, Seoul National University Medical Research Center, Seoul, Korea

Background

Effective chronic disease management requires the active participation of patients, communities, and physicians. We examined the impact of the CRMHDP on healthcare use and health outcomes in a population-based PS matched retrospective cohort study over eight years.

Methods

We matched a CRMHDP group (n = 46,865) and a control group (n = 93,730) against healthcare utilisation and conducted difference-in-differences estimations. For the health outcome analysis, the intervention group (n = 27,242) and control group (n = 54,484) were analysed using the Kaplan-Meier method and Cox proportional hazard regression.

Results

The difference-in-differences estimation of the average annual clinic visits per person and the average annual days covered were 1.26 (95% confidence interval, 1.13-1.39) and 22.97 (95% CI, 20.91-25.03), respectively, between the intervention and control groups. The adjusted hazard ratio for death in the intervention group, compared to the control group, was 0.90 (95% CI, 0.86-0.93). For stroke and chronic renal failure, the adjusted hazard ratios for the intervention group compared to the control group were 0.94 (95% CI, 0.88-0.99) and 0.80 (95% CI 0.73-0.89), respectively.

Conclusion

Our study suggests that for effective chronic disease management both elderly patients and physicians need to be motivated by community support.

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