title: Effect of a structured diabetes education programme in primary care on hospitalizations and emergency department visits among people with Type 2 diabetes mellitus: results from the Patient Empowerment Programme.
abstract: To assess whether a structured diabetes education programme, the Patient Empowerment Programme, was associated with a lower rate of all-cause hospitalization and emergency department visits in a population-based cohort of patients with Type 2 diabetes mellitus in primary care.
  
  
  
  A cohort of 24 250 patients was evaluated using a linked administrative database during 2009-2013. We selected 12 125 patients with Type 2 diabetes who had at least one Patient Empowerment Programme session attendance. Patients who did not participate in the Patient Empowerment Programme were matched one-to-one with patients who did, using the propensity score method. Hospitalization events and emergency department visits were the events of interest. Cox proportional hazard and negative binomial regressions were performed to estimate the hazard ratios for the initial event, and incidence rate ratios for the number of events.
  
  
  
  During a median 30.5 months of follow-up, participants in the Patient Empowerment Programme had a lower incidence of an initial hospitalization event (22.1 vs 25.2%; hazard ratio 0.879; P < 0.001) and emergency department visit (40.5 vs 44%; hazard ratio 0.901; P < 0.001) than those who did not participate in the Patient Empowerment Programme. Participation in the Patient Empowerment Programme was associated with a significantly lower number of emergency department visits (incidence rate ratio 0.903; P < 0.001): 40.4 visits per 100 patients annually in those who did not participate in the Patient Empowerment Programme vs. 36.2 per 100 patients annually in those who did. There were significantly fewer hospitalization episodes (incidence rate ratio 0.854; P < 0.001): 20.0 hospitalizations per 100 patients annually in those who did not participate in the Patient Empowerment Programme vs. 16.9 hospitalizations per 100 patients annually in those who did.
  
  
  
  Among patients with Type 2 diabetes, the Patient Empowerment Programme was shown to be effective in delaying the initial hospitalization event and in reducing their frequency.
authors.affiliation: Department of Family Medicine and Primary Care, University of Hong Kong. carlosho@hku.hk.
authors.forename: C K H
authors.identifier: 0000-0002-6895-6071
authors.initials: CK
authors.lastname: Wong
authors.affiliation: Department of Family Medicine and Primary Care, University of Hong Kong.
authors.forename: W C W
authors.initials: WC
authors.lastname: Wong
authors.affiliation: Department of Family Medicine and Primary Care, University of Hong Kong.
authors.forename: Y F
authors.initials: YF
authors.lastname: Wan
authors.affiliation: Department of Family Medicine and Primary Care, University of Hong Kong.
authors.forename: A K C
authors.initials: AK
authors.lastname: Chan
authors.affiliation: Integrated Care Programs, Hospital Authority Head Office, Hong Kong Hospital Authority, Hong Kong.
authors.forename: F W K
authors.initials: FW
authors.lastname: Chan
authors.affiliation: Department of Family Medicine and Primary Care, University of Hong Kong.
authors.forename: C L K
authors.initials: CL
authors.lastname: Lam
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods / Q000458:organization & administration* / Q000592:standards; D010358:Patient Participation / Q000379:methods / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000379:methods / Q000458:organization & administration*