Al Kathiry Dalal Abdulaziz, Al Slail Fatima, Al-Surimi Khaled, Abusaris Raghib
Ministry of Health, Directorate General of Health Programs and Non-Communicable Disease, Riyadh, Saudi Arabia.
Department of Health Systems and Management, College of Public Health and Health Informatics King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Glob J Qual Saf Healthc. 2021 Jun 8;4(3):88-95. doi: 10.36401/JQSH-20-45. eCollection 2021 Aug.
Noncommunicable diseases are one of the main challenges that affect health worldwide and have been found to be increasing in both low- and middle-income countries compared with high-income countries. The aim of this study was to assess the impact of financial incentives and a comprehensive care program focusing on patients' behavior and self-management of uncontrolled type 2 diabetes (glycosylated hemoglobin [HbA1c] ≥ 7), as well as modifiable risk factors for disease complications in a Saudi Arabian population.
This quasiexperimental study, using a pre- and postevaluation approach, was used to compare the level of HbA1c among patients with uncontrolled diabetes before and after the financial incentives and comprehensive care program were implemented. Financial awards were given to patients who achieved a significantly greater decrease in HbA1c levels with his/her responsible physician. The study population included 702 Saudi Arabian patients with type 2 diabetes from 14 regions and 34 primary healthcare centers in the Kingdom of Saudi Arabia. All of these patients (≥ 15 years old) with uncontrolled type 2 diabetes who attended local primary healthcare centers in Saudi Arabia for a follow-up visit from February to October 2018.
The mean age, in years, of the sample was 56.14 (± SD = 9.909); slightly more than half of the patients 401 (57.1%) were females. Most of the participants 645 (91.9%) were married, and 381(54.3%) patients were housewives. Linear mixed modeling revealed that all groups showed improvements over time in the primary outcome of HbA1c levels ( = 0.009), Including the secondary outcomes of body mass index and systolic and diastolic blood pressure ( = 0.04, < 0.001, 0.019 respectively).
Patient behavior was improved, which was reflected by decreases in HbA1c, body mass index, and blood pressure levels. A comprehensive care program is recommended by healthcare providers to increase awareness among patients with diabetes to reduce other risk factors. These kinds of interventions positively motivate patients with diabetes to control their health measurements and to adopt a healthy lifestyle.
非传染性疾病是影响全球健康的主要挑战之一，并且已发现与高收入国家相比，低收入和中等收入国家的此类疾病正在增加。本研究的目的是评估经济激励措施以及一项针对沙特人群中未控制的2型糖尿病（糖化血红蛋白[HbA1c]≥7）患者的行为和自我管理以及疾病并发症的可改变风险因素的综合护理计划的影响。
本准实验研究采用前后评估方法，用于比较实施经济激励措施和综合护理计划前后未控制糖尿病患者的HbA1c水平。对于HbA1c水平与负责医生共同实现显著更大降幅的患者给予经济奖励。研究人群包括来自沙特阿拉伯王国14个地区和34个初级医疗保健中心的702名沙特2型糖尿病患者。所有这些年龄≥15岁、未控制2型糖尿病的患者于2018年2月至10月在沙特当地初级医疗保健中心进行随访。
样本的平均年龄为56.14岁（±标准差=9.909）；略多于一半的患者401名（57.1%）为女性。大多数参与者645名（91.9%）已婚，381名（54.3%）患者为家庭主妇。线性混合模型显示，所有组在HbA1c水平这一主要结局方面均随时间有所改善（P = 0.009），包括体重指数以及收缩压和舒张压这些次要结局（分别为P = 0.04、P < 0.001、P = 0.019）。
患者行为得到改善，这表现为HbA1c、体重指数和血压水平的下降。医疗保健提供者建议实施综合护理计划，以提高糖尿病患者对降低其他风险因素的认识。此类干预措施能积极激励糖尿病患者控制自身健康指标并采取健康的生活方式。
