Faculty of Health Sciences, School of Pharmacy, University of Eastern Finland, P.O.Box. 1627, FI-70211, Kuopio, Finland.
Joint Municipal Authority for North Karelia Social and Health Services (Siun Sote), Joensuu, Finland.
BMC Health Serv Res. 2020 Nov 27;20(1):1095. doi: 10.1186/s12913-020-05952-6.
A new special reimbursement scheme (SRS) for non-insulin medications used for treatment of hyperglycaemia in type 2 diabetes (T2D) was implemented in Finland on January 1, 2017. The new SRS affected all community-dwelling Finnish T2D patients as all community-dwelling residents are eligible for reimbursement for prescription medications. The aim of the study was to evaluate the impact of this co-payment increase on glycaemic control among Finnish T2D patients.
Data on glycaemic control were collected with HbA1c measures from electronic health records from primary health care and specialized care in the North Karelia region, Finland, from patients with a confirmed T2D diagnosis in 2012 who were alive on January 1, 2017 (n = 8436). Average HbA1c levels were measured monthly 36 months before and 33 months after the policy change. Consumption of diabetes medications was measured with defined daily doses (DDDs) based on reimbursed medication purchases. Interrupted time series design analysed with segmented regression model was applied to examine the effect of the policy change on average HbA1c levels.
Eight thousand one hundred forty-three T2D patients had at least one HbA1c measurement within 01/2014-9/2019. Mean age of the patients was 68.1 (SD 11.3) years and 53.0% were women. Average time since T2D diagnosis was 11.5 (SD 6.1) years. An estimated increase of 0.81 (95% confidence interval, CI, 0.04-1.58) mmol/mol in average HbA1c levels was detected at the time of the policy change. In subgroup analyses, strongest effects were detected among patients who used only other diabetes medications than insulin or metformin in 2016 (3.56 mmol/mol, 95% CI 2.50-4.62). Meanwhile, yearly consumption of diabetes medications decreased slightly from 618.9 (SD 487.8) DDDs/patient in 2016 to 602.9 (SD 475.6) DDDs/patient in 2017 (p = 0.048).
Simultaneously with the increase of the co-payment level, the average HbA1c level increased among T2D patients from the North Karelia region, Finland. This may be explained by the decreased consumption of diabetes medications between 2016 and 2017. Special attention should be allocated to glycaemic control of patients utilizing only other antidiabetic medications than metformin or insulin.
2017 年 1 月 1 日，芬兰实施了一种新的非胰岛素类药物治疗 2 型糖尿病（T2D）的特殊报销方案（SRS）。新的 SRS 影响了所有居住在社区的芬兰 T2D 患者，因为所有居住在社区的居民都有资格报销处方药。本研究的目的是评估这种共同支付增加对芬兰 T2D 患者血糖控制的影响。
从芬兰北卡累利阿地区的初级保健和专科保健的电子健康记录中收集了 2012 年确诊的 T2D 患者的血糖控制数据，这些患者在 2017 年 1 月 1 日仍然存活（n=8436）。在政策变化前 36 个月和后 33 个月每月测量平均 HbA1c 水平。根据报销药物购买情况，使用规定的日剂量（DDD）测量糖尿病药物的使用情况。采用分段回归模型分析中断时间序列设计，以检查政策变化对平均 HbA1c 水平的影响。
8143 名 T2D 患者在 2014 年 1 月至 2019 年 9 月期间至少有一次 HbA1c 测量值。患者的平均年龄为 68.1（SD 11.3）岁，53.0%为女性。T2D 诊断后的平均时间为 11.5（SD 6.1）年。政策变化时，平均 HbA1c 水平估计增加了 0.81（95%置信区间，CI，0.04-1.58）mmol/mol。在亚组分析中，在 2016 年仅使用胰岛素或二甲双胍以外的其他糖尿病药物的患者中，效果最强（3.56mmol/mol，95%CI 2.50-4.62）。与此同时，2016 年每位患者的糖尿病药物年消耗量从 618.9（SD 487.8）DDD/患者降至 2017 年的 602.9（SD 475.6）DDD/患者（p=0.048）。
随着共同支付水平的提高，芬兰北卡累利阿地区的 T2D 患者的平均 HbA1c 水平也有所升高。这可能是由于 2016 年至 2017 年间糖尿病药物的消耗量减少所致。应特别关注仅使用二甲双胍或胰岛素以外的其他抗糖尿病药物的患者的血糖控制。
