| Summary: | 碩士 === 亞洲大學 === 健康管理研究所 === 94 === Background: Besides adequate medications, long-term diabetes mellitus control depends on comprehensive education programs. To enhance delivery of education program to diabetic subjects in various medical setting, Bureau of National Health Insurance proposed a Share Care Disease Management Program for the Diabetes on November 2001 and expected to slow down diabetes progression and control medical utilization via financial incentive.
Purpose: To investigate diabetic patients’ adherence, treatment efficacy, and medical utilization after they participated the program. To study whether the program improved adherence. And further to compare the treatment efficacy and medical utilization between patients who received standard education and patients who did not.
Methods: A total of 487 subjects were selected via 2-steps from 1243 patients who had joined this program for at least 25 months between May 2002 and March 2005. These patients had received at least 684 days (90% of the observe duration) medication and at least 4 times of education from nurse and dietitian. All these data were collected retrospectively and analyzed with SPSS 10.0 software.
Results: The baseline characteristics of study cases were lower average age, lower education background, majority with DM history less than 5 years, less with insulin injection, and less with severe complications. Adherence to medication (85.5%) was scored the highest in the adherence evaluation result. DM-passport usage (82%), diet-behavior learning (67.2%), diet-modification (67%), and exercise (56.5%) were scored items in sequence. Medication, exercise, DM-passport usage and total scores as dependent variable were significant via multiple regression analysis. Regression of HbA1c efficacy showed that beta coefficient was highest in baseline HbA1c, then insulin injection, duration between 6 years and 10 years in sequence. In DM relevant utilization, regression of outpatient expense showed that beta coefficient was highest in baseline Hba1c, then severe complications, duration between 6 years and 10 years, duration between 11 years and 20 years, overweigh or obese, duration more than 21 years, and education-frequency in sequence. Regression of emergency expense showed that beta coefficient of education-frequency was higher than insulin injection. Regression of admission expense showed that beta coefficient was highest in duration more than 21 years, then education-frequency, hypercholesterolemia, and baseline Hba1c in sequence. Regression of total DM relevant expense showed that beta coefficient was highest in baseline Hba1c, then duration more than 21 years, severe complication, duration between 6 years and 10 years, overweigh or obese, duration between 11 years and 20 years, and hypercholesterolemia in sequence. Regression of outpatient visit showed that severe complication was the only significant variable. Regression of emergency frequency showed that education-frequency was the only significant variable. Regression of admission frequency showed that beta coefficient of education-frequency was higher than severe complication. Regression of admission days showed that beta coefficient of independent variable was highest in severe complication, then education-frequency, duration more than 21 years, and hypercholesterolemia in sequence. In non-DM relevant utilization, Regression of the emergency expense and admission frequency showed that beta coefficient of education-frequency was higher than severe complication. Regression of admission expense, total expense, and admission days showed that beta coefficient of severe complication was higher than education-frequency. Regression of diabetic medication expense of outpatient and both outpatient and admission showed that beta coefficient was highest in baseline Hba1c, then duration between 11 years and 20 years, duration between 6 years and 10 years, duration more than 21 years, age, and sex in sequence. Regression of diabetic medication expense of admission showed that beta coefficient of severe complication was higher than education-frequency. Regression of total 25 months expense showed that beta coefficient was highest in severe complication, then education-frequency, duration between 11 years and 20 years in sequence.
Conclusion: Patients’25-months data after enrolled into Shared Care Disease Management Program for the Diabetes had been analyzed. This research found that age, baseline HbA1c, severe complication and education-frequency were very important factors for adherence. The older ones and those received more education-frequency showed better adherence. Patients with higher baseline HbA1c and with severe complication showed worse adherence. The treatment efficacy was better in ones with higher baseline HbA1c. Patients with insulin treatment and with longer history had worse treatment efficacy. But education-frequency didn’t show significance in HbA1c treatment efficacy. The most important factors to increase utilization were long duration and severe complication. Although more education-frequency would spend more DM-relevant outpatient expense, it did decrease emergency expense, admission expense, emergency frequency, admission frequency, and admission days. Besides, it decreased non-DM relevant emergency expense, admission expense, emergency frequency, and admission frequency. And it also decreased diabetes-medication expense of admission and total 25 months expense.
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