A cluster-randomized trial of the effectiveness of a triple-faceted intervention promoting adherence to primary care physician visits by diabetes patients: J-DOIT2 large-scale trial (J-DOIT2-LT)

Mitsuhiko Noda,Katsuya Yamazaki,Hikari Suzuki,Masashi Kobayashi,Atsushi Goto,Yasuaki Hayashino,Masayuki Kato,Kazuo Izumi

doi:10.1038/s41598-020-59588-x

Abstract

We aimed to assess whether a triple-faceted intervention program administered in the primary care setting could decrease the risk of insufficient adherence to primary care physician (PCP) appointments among this patient population. We conducted a cluster-randomized controlled study to assess the effects of a 1-year intervention. The primary outcome was insufficient adherence to regular PCP attendance for diabetes treatment, defined as failure to visit a PCP within 2 months of an original appointment date. The intervention consisted of mailing patient reminders of their PCP appointments, providing patients with health education aimed at lifestyle modification and benchmarking PCP procedures. Eleven municipal level district medical associations employing 192 PCPs were divided into two subregions for assignment to intervention and control clusters, with 971 and 1,265 patients assigned to the intervention and control groups, respectively. Primary outcome data were available for 2,200 patients. The intervention reduced insufficient adherence to regular PCP appointments by 63% (hazard ratio, 0.37; 95% confidence interval [CI], 0.23–0.58). In conclusion, a triple-faceted intervention program consisting of health education, appointment reminders, and physician benchmarking may decrease the risk of incomplete adherence to regular PCP appointments by diabetes patients.

Highlights

We aimed to assess whether a triple-faceted intervention program administered in the primary care setting could decrease the risk of insufficient adherence to primary care physician (PCP) appointments among this patient population
Patients who do not regularly visit their primary care physicians (PCPs) tend to have poorer glycemic and obesity control[14,15,16], both of which may lead to poor health outcomes that result in the development of diabetic complications[17]
To address this research gap, the Japan Diabetes Outcome Intervention Trial 2 (J-DOIT2) investigated whether provision of a triple-faceted intervention program in the primary care setting could decrease the risk of insufficient adherence to regular PCP appointments by patients that have been diagnosed with type 2 diabetes and tested the hypothesis that intervention efficacy will vary according to specific patient characteristics

Summary

Introduction

We aimed to assess whether a triple-faceted intervention program administered in the primary care setting could decrease the risk of insufficient adherence to primary care physician (PCP) appointments among this patient population. The incidence and prevalence of type 2 diabetes are rapidly increasing worldwide[1,2,3,4], including in Japan, where a national survey estimated that the number of patients with diabetes had increased from 6.9 to 9.5 million between 1997 and 20125,6 This rate of increase is a significant concern because epidemiologic studies have indicated that type 2 diabetes is an independent risk factor for cardiovascular diseases as well as microvascular complications. To address this research gap, the Japan Diabetes Outcome Intervention Trial 2 (J-DOIT2) investigated whether provision of a triple-faceted intervention program in the primary care setting could decrease the risk of insufficient adherence to regular PCP appointments by patients that have been diagnosed with type 2 diabetes and tested the hypothesis that intervention efficacy will vary according to specific patient characteristics

Objectives

Results

Conclusion