title: Effectiveness of a multidisciplinary risk assessment and management programme-diabetes mellitus (RAMP-DM) on patient-reported outcomes.
abstract: Little is known about how the patient-reported outcomes is influenced by multidisciplinary-risk-assessment-and-management-programme for patients with diabetes mellitus (RAMP-DM). This paper aims to evaluate the effectiveness of RAMP-DM on patient-reported outcomes. This was a prospective longitudinal study on 1039 diabetes mellitus patients (714/325 RAMP-DM/non-RAMP-DM) managed in primary care setting. 536 and 402 RAMP-DM participants, and 237 and 187 non-RAMP-DM participants were followed up at 12 and 24 months with completed survey, respectively. Patient-reported outcomes included health-related quality of life, change in global health condition and patient enablement measured by Short Form-12 Health Survey version-2 (SF-12v2), Global Rating Scale, Patient Enablement Instrument respectively. The effects of RAMP-DM on patient-reported outcomes were evaluated by mixed effect models. Subgroup analysis was performed by stratifying haemoglobin A1c (HbA1c) (optimal HbA1c < 7 % and suboptimal HbA1c ≥ 7 %). RAMP-DM with suboptimal HbA1c was associated with greater improvement in SF-12v2 physical component summary score at 12-month (coefficient:3.80; P-value < 0.05) and 24-month (coefficient:3.82;P-value < 0.05), more likely to feel more enabled at 12-month (odds ratio: 2.57; P-value < 0.05), and have improved in GRS at 24-month (odds ratio:4.05; P-value < 0.05) compared to non-RAMP-DM participants. However, there was no significant difference in patient-reported outcomes between RAMP-DM and non-RAMP-DM participants with optimal HbA1c. Participation in RAMP-DM is effective in improving physical component of HRQOL, Global Rating Scale and patient enablement among diabetes mellitus patients with suboptimal HbA1c, but not in those with optimal HbA1c. Patients with sub-optimal diabetes mellitus control should be the priority target population for RAMP-DM. This observational study design may have potential bias in the characteristics between groups, and randomized clinical trial is needed to confirm the results.
authors.affiliation: Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau Clinic, 3/F., 161 Main Street, Ap Lei Chau, Hong Kong. yfwan@hku.hk.
authors.forename: Eric Yuk Fai
authors.identifier: http://orcid.org/0000-0002-6275-1147
authors.initials: EY
authors.lastname: Wan
authors.affiliation: Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau Clinic, 3/F., 161 Main Street, Ap Lei Chau, Hong Kong.
authors.forename: Colman Siu Cheung
authors.initials: CS
authors.lastname: Fung
authors.affiliation: Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau Clinic, 3/F., 161 Main Street, Ap Lei Chau, Hong Kong.
authors.forename: Carlos King Ho
authors.initials: CK
authors.lastname: Wong
authors.affiliation: School of Nursing, The University of Hong Kong, 4/F William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong.
authors.forename: Edmond Pui Hang
authors.initials: EP
authors.lastname: Choi
authors.affiliation: Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau Clinic, 3/F., 161 Main Street, Ap Lei Chau, Hong Kong.
authors.forename: Fang Fang
authors.initials: FF
authors.lastname: Jiao
authors.affiliation: Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau Clinic, 3/F., 161 Main Street, Ap Lei Chau, Hong Kong.
authors.forename: Anca Ka Chun
authors.initials: AK
authors.lastname: Chan
authors.affiliation: Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau Clinic, 3/F., 161 Main Street, Ap Lei Chau, Hong Kong.
authors.forename: Karina Hiu Yen
authors.initials: KH
authors.lastname: Chan
authors.affiliation: Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau Clinic, 3/F., 161 Main Street, Ap Lei Chau, Hong Kong.
authors.forename: Cindy Lo Kuen
authors.initials: CL
authors.lastname: Lam
mesh_terms: D000368:Aged; D003920:Diabetes Mellitus / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D000071066:Patient Reported Outcome Measures; D011320:Primary Health Care; D011446:Prospective Studies; D011788:Quality of Life; D018570:Risk Assessment
keywords: Diabetes mellitus; Multidisciplinary-risk-assessment-and-management-programme; Patient-reported outcomes