Overcoming disparities in diabetes care: eight years' experience changing the diabetes care system in Changhua, Taiwan

Yeh, Yen-Po; Chang, Chun–Ju; Hsieh, Min-Ling; Wu, Huiting

doi:10.1016/s0168-8227(14)70736-3

Cited by 7 publications

(8 citation statements)

References 16 publications

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“…However, the arbitrariness of patient enrollment in DMP4P could also produce a selection bias in that study. Another study on participants of a diabetes management program in Changhua reported a 92.2% completion rate of A1c examination in 2012 [ 20 ]. According to that study, the result was better in the participants than in the general population, demonstrating the efficacy of the diabetes management program.…”

Section: Discussionmentioning

confidence: 99%

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Team-based care improves quality of diabetes care -Family Practice Integrated Care Project in Taiwan

et al. 2020

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Background The Family Practice Integrated Care Project (FPICP) is a team-based program in Taiwan initiated in 2003. This study investigates the influence of FPICP on the quality of diabetes care. Methods This population-based cohort study used Taiwan’s National Health Insurance Administration data on FPICP (fiscal year 2015–2016, with follow-up duration of one year). Participants included diabetic patients aged ≥30 in primary care clinics. We used conditional logistic regression modeling of patient characteristics and annual diabetes examinations and compared FPICP participants with non-participating candidates. Main outcome measures included completion of annual diabetes examinations, including glycated hemoglobin (A1c), low-density lipoprotein (LDL), urine microalbumin (MAU), routine urinalysis (UR), and fundus examination (FE). Results The sample included 298,208 FPICP participants and 478,778 non-participating candidates. After 1:1 propensity score matching, the examination completion rates for FPICP participants and non-participants, respectively, were 94.4% versus 93.6% in A1c, 84.2% versus 83.8% in LDL, 61.9% versus 60.1% in MAU, 59.2% versus 58.0% in UR, and 30.1% versus 32.4% in FE. Conclusion Our findings indicate that a program like FPICP helps improve the quality of diabetes care through regular examinations of Alc, LDL, MAU, and UR.

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Section: Discussionmentioning

confidence: 99%

“…The completion rates of diabetes-related examinations vary among different studies in Taiwan [17][18][19][20]. The variety might be a result of the year of study, the level of hospitals/clinics providing services, the accessibility of medical resources, and the intervention of healthcare programs among the cohorts.…”

Section: Interpretation Of the Findingsmentioning

confidence: 99%

Team-based care improves quality of diabetes care -Family Practice Integrated Care Project in Taiwan

et al. 2020

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“…Reduced sensitivity of the QFT-GIT and TST in elderly diabetics (figure 3A,B) may lead to false negatives, and therefore underestimate the effect of DM. Second, all patients with DM were enrolled from the DDMP, an intervention designed to facilitate lifestyle modification in patients with DM 12. Thus, these study subjects may have better general health status, and hence lower risk of TB infection, than patients with DM from the general population 19.…”

Section: Discussionmentioning

confidence: 99%

“…We conducted a community-based study that comprised DM and non-DM subjects by combining two community-based programmes to investigate the effect of DM on risk of LTBI in Changhua, a county in Taiwan with a TB incidence of 58.7 per 100 000 and a BCG vaccination coverage of around 99% in 2012 11. The first programme recruited the DM group from patients registered in the Changhua Diabetes Shared Care (CHDSC) programme12 to participate in the LTBI survey. The second recruited the community comparison (CC) group from participants of a community-based LTBI screening programme 13.…”

Section: Methodsmentioning

confidence: 99%

“…Nearly 60% of patients with DM in Changhua were enrolled in the national diabetes disease management programme (DDMP) and registered in the CHDSC 12. These enrollees were suitable to be included as the study subjects, because their DM status had been ascertained by certified physicians who provided diabetes care according to national guidelines.…”

Section: Methodsmentioning

confidence: 99%

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Effect of diabetes mellitus on risk of latent TB infection in a high TB incidence area: a community-based study in Taiwan

et al. 2019

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ObjectiveTo investigate the association between diabetes and latent tuberculosis infections (LTBI) in high TB incidence areas.DesignCommunity-based comparison study.SettingOutpatient diabetes clinics at 4 hospitals and 13 health centres in urban and rural townships. A community-based screening programme was used to recruit non-diabetic participants.ParticipantsA total of 2948 patients with diabetes aged older than 40 years were recruited, and 453 non-diabetic participants from the community were enrolled.Primary and secondary outcome measuresThe interferon-gamma release assay (IGRA) and the tuberculin skin test were used to detect LTBI. The IGRA result was used as a surrogate of LTBI in logistic regression analysis.ResultsDiabetes was significantly associated with LTBI (adjusted OR (aOR)=1.59; 95% CI 1.11 to 2.28) and age correlated positively with LTBI. Many subjects with diabetes also had additional risk factors (current smokers (aOR=1.28; 95% CI 0.95 to 1.71), comorbid chronic kidney disease (aOR=1.26; 95% CI 1.03 to 1.55) and history of TB (aOR=2.08; 95% CI 1.19 to 3.63)). The presence of BCG scar was protective (aOR=0.66; 95% CI 0.51 to 0.85). Duration of diabetes and poor glycaemic control were unrelated to the risk of LTBI.ConclusionThere was a moderately increased risk of LTBI in patients with diabetes from this high TB incidence area. This finding suggests LTBI screening for the diabetics be combined with other risk factors and comorbidities of TB to better identify high-risk groups and improve the efficacy of targeted screening for LTBI.

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Pay-for-performance in Taiwan: A systematic review and meta-analysis of the empirical literature

Kang,

Chang,

Lin

et al. 2024

Public Health

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Overcoming disparities in diabetes care: eight years' experience changing the diabetes care system in Changhua, Taiwan

Cited by 7 publications

References 16 publications

Team-based care improves quality of diabetes care -Family Practice Integrated Care Project in Taiwan

Team-based care improves quality of diabetes care -Family Practice Integrated Care Project in Taiwan

Effect of diabetes mellitus on risk of latent TB infection in a high TB incidence area: a community-based study in Taiwan

Pay-for-performance in Taiwan: A systematic review and meta-analysis of the empirical literature

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