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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Article info
Publication history
Published online: March 15, 2023
Accepted:
March 8,
2023
Received in revised form:
February 23,
2023
Received:
September 22,
2022
Identification
Copyright
© 2023 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.
