增强初级卫生保健（EnPHC）干预措施对马来西亚 2 型糖尿病管理的效果：双重差分（DID）分析。

The Effectiveness of Enhanced Primary Healthcare (EnPHC) interventions on Type 2 diabetes management in Malaysia: Difference-in-differences (DID) analysis.

机构信息

Institute for Clinical Research, National Institutes of Health, Ministry of Health, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170 Shah Alam, Selangor, Malaysia.

出版信息

Prim Care Diabetes. 2023 Jun;17(3):260-266. doi: 10.1016/j.pcd.2023.03.003. Epub 2023 Mar 15.

DOI:10.1016/j.pcd.2023.03.003

PMID:36932012

Abstract

AIMS

To evaluate the effectiveness of the Enhanced Primary Healthcare (EnPHC) interventions on process of care and intermediate clinical outcomes among type 2 diabetes patients.

METHODS

This was a quasi-experimental controlled study conducted in 20 intervention and 20 control public primary care clinics in Malaysia from November 2016 to June 2019. Type 2 diabetes patients aged 30 years and above were selected via systematic random sampling. Outcomes include process of care and intermediate clinical outcomes. Difference-in-differences analyses was conducted.

RESULTS

We reviewed 12,017 medical records of patients with type 2 diabetes. Seven process of care measures improved: HbA1c tests (odds ratio (OR) 3.31, 95% CI 2.13, 5.13); lipid test (OR 4.59, 95% CI 2.64, 7.97), LDL (OR 4.33, 95% CI 2.16, 8.70), and urine albumin (OR 1.99, 95% CI 1.12, 3.55) tests; BMI measured (OR 15.80, 95% CI 4.78, 52.24); cardiovascular risk assessment (OR 174.65, 95% CI 16.84, 1810.80); and exercise counselling (OR 1.18, 95% CI 1.04, 1.33). We found no statistically significant changes in intermediate clinical outcomes (i.e. HbA1c, LDL, HDL and BP control).

CONCLUSIONS

EnPHC interventions was successful in enhancing the quality of care, in terms of process of care, by changing healthcare providers behaviour.

摘要

目的

评估强化初级医疗保健（EnPHC）干预措施对 2 型糖尿病患者护理过程和中间临床结局的效果。

方法

这是一项在马来西亚 20 个干预和 20 个对照公立初级保健诊所进行的准实验对照研究。从 2016 年 11 月至 2019 年 6 月，通过系统随机抽样选择年龄在 30 岁及以上的 2 型糖尿病患者。结局包括护理过程和中间临床结局。采用差异-差异分析。

结果

我们回顾了 12017 例 2 型糖尿病患者的病历。有 7 项护理过程措施得到改善：糖化血红蛋白（HbA1c）检测（比值比（OR）3.31，95%置信区间（CI）2.13，5.13）；血脂检测（OR 4.59，95% CI 2.64，7.97）、LDL（OR 4.33，95% CI 2.16，8.70）和尿白蛋白（OR 1.99，95% CI 1.12，3.55）检测；体重指数（BMI）测量（OR 15.80，95% CI 4.78，52.24）；心血管风险评估（OR 174.65，95% CI 16.84，1810.80）；以及运动咨询（OR 1.18，95% CI 1.04，1.33）。我们没有发现中间临床结局（即 HbA1c、LDL、HDL 和血压控制）有统计学意义的变化。