A Retrospective Combination Health Outcomes Study among Diabetic Patients with Chronic Kidney Disease: A Multi-Level Study

Abstract

Diabetes is the prominent cause of the progression of chronic kidney diseases (CKD) worldwide. Effective implementation of healthcare services and healthcare delivery system to control glycemic level and slow annually declining eGFR remain a challenge in many countries including Thailand. The aims of this study were to investigate the association between individual and health service delivery factors on the combination health outcomes. This multi-level study applied case-control method was conducted. The 397 participants were recruited from 11 hospitals during December 2018 to May 2019 in Thailand. The samples were categorized into 4-group combination health outcome. Data analysis was performed by descriptive analysis and multi-level multinomial logistic regression analysis. The multinomial logistic regression in bivariate analysis showed that diabetes self-care activities score were more likely to control glycemic and CKD progression compared with those with a low-level of DSCA (OR 3.47; 95 % CI: 1.19 - 10.15). The rational drug uses (RDU) as the health service-level factors increased combination health outcomes 2 times (OR 2.41; 95 % CI: 1.05 - 5.53). The multi-level analysis found that performing with high-level of DSCA (OR 5.36; 95 % CI :1.99 - 14.46) and rational drug uses of metformin and NSAIDs (OR 2.33; 95 % CI: 1.25 - 4.36) increased probability to achieve combination health outcomes. Findings highlight the importance of diabetes self-care activities and health service delivery system to optimize the combination health outcomes among diabetic patients with CKD.
 HIGHLIGHTS
 
 The glycemic control and slow kidney disease progression could decrease diabetic complications
 The challenges of complicate diseases management involved patient-level and health service-level factors
 The high-level of DSCA showed the significant association with glycemic control and slow kidney disease progression
 This study encourages professional nurses promote the model of care that appropriate for individual person who had the difference of age, BMI and self-care activities level
 
 GRAPHICAL ABSTRACT