The Diabetes Medical Benefit Improvement Project improves serum HbA1c concentrations of DM patients in primary health clinics

• Main Authors: Kuei-Mei Chu, 朱桂美
• Other Authors: Alan C. Tsai
• Format: Others
• Language: zh-TW
• Published: 2008
• Online Access: http://ndltd.ncl.edu.tw/handle/58638639376114673246

碩士 === 亞洲大學 === 長期照護研究所 === 96 === Background and objective: The Diabetes Medical Benefit Improvement Project is an incentive mechanism of the Shared-Care Model promoted by the Universal Healthcare Insurance of Taiwan for diabetics aiming at improving the efficiency of diabetic care, especially at the primary local health clinics. Although the potential benefit of the Shared-Care Model at teaching or area hospitals has been demonstrated, such observation has not been made at the level of primary health clinics. Thus, this study was aimed to make such an observation. Method: The study purposively sampled diabetics in three primary health clinics in Taichung County. A total of 198 subjects was enrolled in this study and all participants who have joined the program for >12 months. Among them, 139 have joined the program for two years and 79 for three years. Each subject's health and nutrition education, clinic visits, self-care behaviors, biomarkers, health indicators and personal data were retrospectively extracted from the record. Data were then analyzed with SPSS/Windows 10.0 Statistical Package. Results: The program was effective in reducing serum level of HbA1c, a biomarker of blood glucose control, and the average reduction was 1% during the first year of the program. Serum HbA1c was kept at the same reduced level during the second year but it increased to nearly the baseline (initial) level at the end of the third year. Regression analysis showed that health and nutrition education, frequency of clinic visit, hypertension control and family history were the major factors associated with the effectiveness of the program whereas hypertension and cigarette-smoking were two major factors associated with the increase in HbA1c. Conclusion: Results of this study suggest that the Diabetes Medical Benefit Improvement Project of the Shared-Care Model is effective in improving diabetic control at least during the first two years of the program. It can help to delay the development of diabetic complications. Health education and hypertension & smoking control appear to be the major factors impacting the effectiveness of the program. Future studies should be concentrated on finding ways to improve or extend the effectiveness of the program.