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Research Article| Volume 17, ISSUE 3, P260-266, June 2023

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

  • Masliyana Husin
    Correspondence
    Correspondence to: Institute for Clinical Research, National Institutes of Health, Ministry of Health, No. 1, Jalan Setia Murni U13/52, Seksyen U13, 40170 Shah Alam, Selangor, Malaysia.
    Affiliations
    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
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  • Xin Rou Teh
    Affiliations
    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
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  • Su Miin Ong
    Affiliations
    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
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  • Yvonne Mei Fong Lim
    Affiliations
    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
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  • Swee Hung Ang
    Affiliations
    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
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  • Chee Lee Chan
    Affiliations
    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
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  • Ming Tsuey Lim
    Affiliations
    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
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  • Sunita Shanmugam
    Affiliations
    Institute for Health Management, National Institutes of Health, Ministry of Health, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170 Shah Alam, Selangor, Malaysia
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  • Noraziani Khamis
    Affiliations
    Institute for Health Management, National Institutes of Health, Ministry of Health, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170 Shah Alam, Selangor, Malaysia
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  • Faeiz Syezri Adzmin Jaafar
    Affiliations
    Institute for Health Management, National Institutes of Health, Ministry of Health, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170 Shah Alam, Selangor, Malaysia
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  • Nor Idawaty Ibrahim
    Affiliations
    Family Health Development Division, Ministry of Health Malaysia, Kompleks E, Pusat Pentadbiran Kerajaan Persekutuan, 62590 Putrajaya, Malaysia
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  • Nazrila Hairizan Nasir
    Affiliations
    Family Health Development Division, Ministry of Health Malaysia, Kompleks E, Pusat Pentadbiran Kerajaan Persekutuan, 62590 Putrajaya, Malaysia
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  • Dian Kusuma
    Affiliations
    Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States

    Department of Health Services Research and Management, School of Health & Psychological Sciences, City University of London, London, United Kingdom
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  • Anita Katharina Wagner
    Affiliations
    Harvard Medical School and Harvard Pilgrim Health Care Institute, Landmark Center, 401 Park Dr #401, Boston, MA 02215, United States
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  • Dennis Ross-Degnan
    Affiliations
    Harvard Medical School and Harvard Pilgrim Health Care Institute, Landmark Center, 401 Park Dr #401, Boston, MA 02215, United States
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  • Rifat Atun
    Affiliations
    Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States
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  • Sheamini Sivasampu
    Affiliations
    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
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Published:March 15, 2023DOI:https://doi.org/10.1016/j.pcd.2023.03.003

      Highlights

      • EnPHC is a multifaceted intervention that exists as an integrated care mode.
      • It improved seven out of fourteen processes of care in diabetes management.
      • Intermediate clinical outcomes such as HbA1c, LDL, and HDL were also measured.
      • Targets were met for three out of four outcomes, but they were not statistically significant.

      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.

      Keywords

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