Effects of Patient Empowerment Programme (PEP) on clinical outcomes and health service utilization in type 2 diabetes mellitus in primary care: an observational matched cohort study.
BACKGROUND
To evaluate the effects of a large population-based patient empowerment programme (PEP) on clinical outcomes and health service utilization rates in type 2 diabetes mellitus (T2DM) patients in the primary care setting.


METHODS
A stratified random sample of 1,141 patients with T2DM enrolled to PEP between March and September 2010 were selected from general outpatient clinics (GOPC) across Hong Kong and compared with an equal number of T2DM patients who had not participated in the PEP (non-PEP group) matched by age, sex and HbA1C level group.


METHODS
Clinical outcomes of HbA1c, SBP, DBP and LDL-C levels, and health service utilization rates including numbers of visits to GOPC, specialist outpatient clinics (SOPC), emergency department (ED) and inpatient admissions, were measured at baseline and at 12-month post-recruitment. The effects of PEP on clinical outcomes and health service utilization rates were assessed by the difference-in-difference estimation, using the generalized estimating equation models.


RESULTS
Compared with non-PEP group, PEP group achieved additional improvements in clinical outcomes over the 12-month period. A significantly greater percentage of patients in the PEP group attained HbA1C≤7% or LDL-C≤2.6 mmol/L at 12-month follow-up compared with the non-PEP group. PEP group had a mean 0.813 fewer GOPC visits in comparison with the non-PEP group.


CONCLUSIONS
PEP was effective in improving the clinical outcomes and reduced the general outpatient clinic utilization rate over a 12-month period. Empowering T2DM patients on self-management of their disease can enhance the quality of diabetes care in primary care.


BACKGROUND
ClinicalTrials.gov NCT01935349.
Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong.
Carlos K H
CK
Wong
Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong.
William C W
WC
Wong
Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong.
Cindy L K
CL
Lam
Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong.
Y F
YF
Wan
Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong.
Winnie H T
WH
Wong
Integrated Care Programs, Hospital Authority Head Office, Hong Kong Hospital Authority, Kowloon, Hong Kong.
K L
KL
Chung
Primary and Community Services, Hospital Authority Head Office, Hong Kong Hospital Authority, Kowloon, Hong Kong.
Daisy
D
Dai
Statistics and Workforce Planning, Hospital Authority Head Office, Hong Kong Hospital Authority, Kowloon, Hong Kong.
Eva L H
EL
Tsui
School of Nursing, The University of Hong Kong, Hong Kong.
Daniel Y T
DY
Fong
D000368:Aged; D000554:Ambulatory Care Facilities; D015415:Biomarkers / Q000378:metabolism; D015331:Cohort Studies; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000378:metabolism; D005260:Female; D006296:Health Services; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010358:Patient Participation; D011320:Primary Health Care; D012307:Risk Factors
D015415:Biomarkers