Effectiveness of a large community-based Patient Empowerment Program for Chinese patients with diabetes mellitus

Abstract

BACKGROUND: We assessed whether a structured diabetes education programme, Patient Empowerment Programme (PEP), was associated with better clinical outcomes, health service utilization rates and a lower risk of diabetes-related complications and all-cause mortality in type 2 diabetes mellitus (T2DM) patients in the primary care setting. METHODS: A Chinese cohort of T2DM patients without prior occurrence of events on or before baseline study recruitment date was linked to the Hong Kong administrative database from 2008 to 2013. Clinical 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. Cox proportional hazard regressions were performed to estimate the associations of PEP with the occurrence of first CVD event, coronary heart disease, stroke, heart failure, death from any cause first microvascular event, retinopathy, nephropathy and neuropathy, controlling for baseline characteristics. RESULTS: Compared 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≤2.6mmol/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. Cox regression reported that PEP participants had a lower incidence of all-cause mortality (hazard ratio: 0.564; P<0.001), first CVD (hazard ratio: 0.807; P=0.004), stroke (hazard ratio: 0.702; P=0.001) and first microvascular event (hazard ratio: 0.854; P=0.001) and nephropathy (hazard ratio: 0.706; P<0.001) events than those without PEP. CONCLUSIONS: PEP was effective in improving the clinical outcomes and reduced the general outpatient clinic utilization rate over a 12-month period. Enrolment in PEP was associated with reduced all-cause mortality, first CVD events, first microvascular events, especially nephropathy, among T2DM patients. The benefit of PEP might be attributable to improving metabolic control through empowerment of self-care and enhancement of quality of diabetes care in primary care.