Effect of a structured diabetes education programme in primary care on hospitalizations and emergency department visits among people with Type 2 diabetes mellitus: results from the Patient Empowerment Programme

Abstract

Aim To assess whether a structured diabetes education programme, the Patient Empowerment Programme, was associated with a lower rate of all‐cause hospitalization and emergency department visits in a population‐based cohort of patients with Type 2 diabetes mellitus in primary care. Methods A cohort of 24 250 patients was evaluated using a linked administrative database during 2009–2013. We selected 12 125 patients with Type 2 diabetes who had at least one Patient Empowerment Programme session attendance. Patients who did not participate in the Patient Empowerment Programme were matched one‐to‐one with patients who did, using the propensity score method. Hospitalization events and emergency department visits were the events of interest. Cox proportional hazard and negative binomial regressions were performed to estimate the hazard ratios for the initial event, and incidence rate ratios for the number of events. Results During a median 30.5 months of follow‐up, participants in the Patient Empowerment Programme had a lower incidence of an initial hospitalization event (22.1 vs 25.2%; hazard ratio 0.879; P < 0.001) and emergency department visit (40.5 vs 44%; hazard ratio 0.901; P < 0.001) than those who did not participate in the Patient Empowerment Programme. Participation in the Patient Empowerment Programme was associated with a significantly lower number of emergency department visits (incidence rate ratio 0.903; P < 0.001): 40.4 visits per 100 patients annually in those who did not participate in the Patient Empowerment Programme vs. 36.2 per 100 patients annually in those who did. There were significantly fewer hospitalization episodes (incidence rate ratio 0.854; P < 0.001): 20.0 hospitalizations per 100 patients annually in those who did not participate in the Patient Empowerment Programme vs. 16.9 hospitalizations per 100 patients annually in those who did. Conclusions Among patients with Type 2 diabetes, the Patient Empowerment Programme was shown to be effective in delaying the initial hospitalization event and in reducing their frequency.

Higher Referrals for Diabetes Education in a Medical Home Model of Care

“…11 We speculate that diabetes education contributes to cost savings because education programs for diabetes have been reported to result in fewer emergency department visits and hospitalizations. 19 The current evidence suggests that the medical home itself, independent of patient illness, accounts for referral to education. First, the OR obtained for the effect of medical home status remained significant after controlling for covariates, several of which were more prevalent among non-medical home patients and were positively associated with diabetes education.…”

Empowerment in the Treatment of Diabetes and Obesity

“…The effects of these therapies are multidirectional. Indeed, participants with type 2 diabetes enrolled in the Patient Empowerment Program were characterized by fewer hospitalizations during the 30-month observation compared to patients who did not participate in the program [22]. In addition, the improvement in the quality of life (through improvement in bodily pain and emotional roles, among others) was noted [23].…”

Long‐term cost‐effectiveness of a Patient Empowerment Programme for type 2 diabetes mellitus in primary care

“…The Hong Kong (HK) Hospital Authority (HA), which manages all publicly funded hospitals in HK, launched a Patient Empowerment Programme (PEP) in 2010 for subjects with type 2 DM who attend public general outpatient clinics (GOPCs) for their diabetes care. A detailed description of the PEP has been published elsewhere . Briefly, enrolled subjects attend generic education sessions that cover the importance of self‐management and behaviour modification, diet, exercise, stress, coping skills and problem‐solving.…”