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

Carlos K H Wong; William C W Wong; Cindy L K Lam; Y F Wan; Winnie H T Wong; K L Chung; Daisy Dai; Eva L H Tsui; Daniel Y T Fong

doi:10.1371/journal.pone.0095328

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

PLoS One. 2014 May 1;9(5):e95328. doi: 10.1371/journal.pone.0095328. eCollection 2014.

Authors

Carlos K H Wong¹, William C W Wong¹, Cindy L K Lam¹, Y F Wan¹, Winnie H T Wong¹, K L Chung², Daisy Dai³, Eva L H Tsui⁴, Daniel Y T Fong⁵

Affiliations

¹ Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong.
² Integrated Care Programs, Hospital Authority Head Office, Hong Kong Hospital Authority, Kowloon, Hong Kong.
³ Primary and Community Services, Hospital Authority Head Office, Hong Kong Hospital Authority, Kowloon, Hong Kong.
⁴ Statistics and Workforce Planning, Hospital Authority Head Office, Hong Kong Hospital Authority, Kowloon, Hong Kong.
⁵ School of Nursing, The University of Hong Kong, Hong Kong.

Abstract

Background: To 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 subjects: A 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.

Measures: 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.

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≤2.6 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.

Conclusions: PEP 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 registration: ClinicalTrials.gov NCT01935349.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Ambulatory Care Facilities
Biomarkers / metabolism
Cohort Studies
Comorbidity
Diabetes Mellitus, Type 2 / epidemiology*
Diabetes Mellitus, Type 2 / metabolism
Female
Health Services*
Hong Kong / epidemiology
Humans
Male
Middle Aged
Outcome Assessment, Health Care
Patient Participation*
Primary Health Care*
Risk Factors

Substances

Biomarkers

Associated data

ClinicalTrials.gov/NCT01935349

Grants and funding

This study has been funded by the Hong Kong Hospital Authority (Ref. no: 8011014157) and the Health and Health Services Research Fund, Food and Health Bureau, HKSAR Commissioned Research on Enhancing Primary Care Study (Ref. no EPC-HKU-2). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.