Tong Xichen, Zou Haiyan, Zhang Luying, Chen Wen
School of Public Health, Fudan University, No.130 Dongan Road, Shanghai, 200032, China.
Institutional Review Board, Huashan Hospital, Fudan University, Shanghai, 200040, China.
BMC Public Health. 2025 Jan 31;25(1):404. doi: 10.1186/s12889-025-21656-0.
Nonadherence to medication is a prevalent issue among patients with type 2 diabetes mellitus (T2DM). The family doctor system promotes continuous, integrated, and personalized primary care, which may improve medication adherence. However, more evidence is needed regarding causal association between family doctor system and medication adherence. This study is to assess the impact of the family doctor system on medication adherence among T2DM patients.
This cohort study utilized data between 2014 and 2019 from three separate administrative databases of an eastern city in China. Adult patients with T2DM who continuously registered with family doctors from 2015 to 2019 (n = 18,841) were assigned to the intervention group, while those who never registered during this period (n = 1,429) were classified as the control group. A difference-in-differences design was employed to compare medication adherence between registered and unregistered T2DM patients after the first stage of family doctor system in 2015 and the second stage in 2018. Propensity score matching was applied to ensure the robustness. The mean proportion of days covered (PDC), and proportion of patients with good adherence (PDC ≥ 80%) were the outcomes of interest. All recommended T2DM medications were included to calculate PDC.
Compared to the unregistered group, PDC across all institutions for registered patients increased by 5.0% (p < 0.001) after the first stage of family doctor system, and by 5.9% (p < 0.001) after the second stage. The proportion of patients with good adherence increased by 9.5% (p < 0.001) and by 11.8% (p < 0.001) after two stages, respectively. The adherence improvement was more pronounced in community health centers. However, the overall good adherence rate among registered patients in 2019 remained relatively low, reaching only 59.77%.
The family doctor system significantly improved medication adherence among T2DM patients by providing patient-centered, continuous, and integrated primary services, especially in community health centers. Nevertheless, further efforts should be made to enhance medication adherence.
不遵医嘱服药是2型糖尿病（T2DM）患者中普遍存在的问题。家庭医生制度促进了持续、综合和个性化的初级保健，这可能会提高药物依从性。然而，关于家庭医生制度与药物依从性之间的因果关系，还需要更多证据。本研究旨在评估家庭医生制度对T2DM患者药物依从性的影响。
这项队列研究利用了中国东部一个城市三个独立行政数据库中2014年至2019年的数据。2015年至2019年持续在家庭医生处登记的成年T2DM患者（n = 18,841）被分配到干预组，而在此期间从未登记的患者（n = 1,429）被归类为对照组。采用差异-in-差异设计，比较2015年家庭医生制度第一阶段和2018年第二阶段后登记和未登记的T2DM患者之间的药物依从性。应用倾向得分匹配以确保稳健性。日覆盖比例（PDC）的均值以及依从性良好患者的比例（PDC≥80%）是感兴趣的结果。纳入所有推荐的T2DM药物以计算PDC。
与未登记组相比，在家庭医生制度第一阶段后，登记患者在所有机构中的PDC增加了5.0%（p < 0.001），在第二阶段后增加了5.9%（p < 0.001）。两个阶段后，依从性良好患者的比例分别增加了9.5%（p < 0.001）和11.8%（p < 0.001）。在社区卫生中心，依从性改善更为明显。然而，2019年登记患者的总体良好依从率仍然相对较低，仅达到59.77%。
家庭医生制度通过提供以患者为中心、持续和综合的初级服务，显著提高了T2DM患者的药物依从性，尤其是在社区卫生中心。尽管如此，仍应进一步努力提高药物依从性。
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