Abstract
Abstract Background The burden type 2 diabetes mellitus (T2DM) is increasing in China, especially in rural areas. The New Round of Health Care Reform in China intended to strengthen primary care, and promote the vertical integration between hospital care and primary care, in order to respond to the threat of T2DM. This study aimed to assess the impact of an educational intervention to improve vertical integration and management of T2DM in primary care in rural China, on glycemic control and diabetes knowledge. Methods The educational intervention was conducted in cooperation between the county level hospitals and primary care in rural areas (including township health centres and village clinics). T2DM patients in three counties in Jiangsu Province were randomly divided into an intervention group, which received an education-based intervention and follow-up visits, and a control group which received standard care. Questionnaire interviews and medical records were used to collect patient data, including fasting blood glucose (FBG) level and diabetes knowledge, at baseline and follow-up, in 2015 and 2016, respectively. Difference-in difference analysis and Mann-Whitney U test were used. Results The FBG level decreased significantly and diabetes knowledge increased significantly in the intervention group compared to the control group. The FBG level and diabetes knowledge score improved significantly in the intervention group in all counties, but there were local variations in levels. Conclusions The increased integration between the county level hospital and primary care service with an educational intervention among T2DM patients had a positive impact on the FBG level and diabetes knowledge score in the intervention group compared to the control group after one year. The results are suggesting that the care of diabetes in rural China may be improved through more intense collaboration between hospital care and primary care. Key messages The increased integration had a positive impact on the glycemic control and diabetes knowledge among T2DM patients. Diabetes care in rural China may be improved through increased collaboration between hospital care and primary care.
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