Effect of community management of type 2 diabetes patients with signing on family doctor service in Shanghai

Abstract

Objective To assess the effect of community management of type 2 diabetes mellitus (T2DM) patients with signing on family doctor service in Shanghai. Methods Six community health service centers in two Shanghai districts were selected by cluster random sampling method from April 2014 to March 2017. T2DM patients, who visited the community health service centers more than three times in the last one year, were enrolled in the study. The questionnaire survey was conducted and lab tests were documented. Results A total of 5 078 T2DM patients were enrolled in this study, among whom 2 033 had signed contract service with family doctors (signing group) with a signing rate of 40.8%. Compared to non-signing group, the patients in the signing group were better followed the recommendations of blood glucose control [64.6% (1 320/2 053) vs. 35.7% (1 061/2 978)], diet [64.6% (1 320/2 053) vs. 35.7% (1 061/2 978)] and physical activity [63.4%(1 295/2 053)vs. 34.8% (1 033/2 978)](χ2=356.507, 400.649 and 393.996, P<0.01). The medication compliance rate and regular exercise rate in signing group were higher than those in non-signing group [80.2% (1 615/2 053) vs. 77.6% (2 272/2 978), χ2=3.894, P< 0.05; 81.8% (1 679/2 053) vs. 74.5% (2 215/2 978), χ2=38.084, P< 0.05]. The control rates of GLU, 2 h PPG, HbA1c, and blood pressure in signing group were higher than those in non-signing group [40.0% (823/2 053) vs. 35.9% (1 069/2 978), 47.3% (971/2 053) vs.45.4% (1 352/2 978), 35.2%(722/2 053) vs. 32.5%(968/2 978), χ2=18.495, 5.218, 5.006, all P<0.05]. Conclusion The community management with signing on family doctor service enhances the improvement of health related behaviors in patients with type 2 diabetes; but currently the rate of contract signing is still low. Key words: Diabetes mellitus; Treatment outcome; Physicians, family; Contract