Increased number of structured diabetes education attendance was not associated with the improvement in patient-reported health-related quality of life: results from Patient Empowerment Programme (PEP)

Carlos K H Wong, William C W Wong, Eric Y F Wan, Winnie H T Wong, Frank W K Chan, Cindy L K Lam, Carlos K H Wong, William C W Wong, Eric Y F Wan, Winnie H T Wong, Frank W K Chan, Cindy L K Lam

Abstract

Aims: To assess the effect of a structured education intervention, Patient Empowerment Programme (PEP) patient-reported health-related quality of life (HRQOL) among type 2 diabetes mellitus (T2DM) patients, and if positive effect is confirmed, to further explore any association between frequency of sessions attendance and HRQOL.

Methods: A total of 298 T2DM patients were recruited when they attended the first session of PEP, between March and September 2010, and were followed over a one-year period from baseline. HRQOL data were assessed using Short Form-12 Health Survey version 2 (SF-12) and Short Form-6 Dimension (SF-6D) at baseline and one-year follow-up. Individuals' anthropometric and biomedical data were extracted from an administrative database in Hong Kong. Unadjusted and adjusted analyses of linear regression models were performed to examine the impact of PEP session attendance on the change in the HRQOL scores, accounting for the socio-demographic and clinical characteristics at baseline.

Results: Of the 298 eligible patients, 257 (86.2%) participated in the baseline assessment and 179 (60.1%) patients completed the follow-up assessment, respectively. Overall, PEP resulted in a significant improvement in SF-12 bodily pain and role emotional subscales and SF-6D utility scores. These positive changes were not associated with the level of participation as shown in both unadjusted and adjusted analyses.

Conclusions: The PEP made significant improvement in bodily pain, role emotional and overall aspects of HRQOL. Higher number of session attendance was not associated with improvement in HRQOL in primary care real-world setting. Key Messages ● Participants with type 2 diabetes mellitus who participated in structured diabetes education programme made significant improvement in bodily pain and role emotional subscales and SF-6D scores. ● There was no association between the number of sessions attended and any aspect of HRQOL.

References

    1. Rubin RR, Peyrot M. Quality of life and diabetes. Diabetes/Metabolism Research and Reviews. 1999;15:205–218. doi: 10.1002/(SICI)1520-7560(199905/06)15:3<205::AID-DMRR29>;2-O.
    1. Peyrot M, Rubin RR. Levels and risks of depression and anxiety symptomatology among diabetic adults. Diabetes Care. 1997;20:585–590. doi: 10.2337/diacare.20.4.585.
    1. Jacobson AM, de Groot M, Samson JA. The evaluation of two measures of quality of life in patients with type I and type II diabetes. Diabetes Care. 1994;17:267–274. doi: 10.2337/diacare.17.4.267.
    1. Glasglow RE, Toobert DJG,CD. Psychosocial barriers to diabetes self-management and quality of life. Diabetes Spectrum. 2001;14:33–41. doi: 10.2337/diaspect.14.1.33.
    1. Peyrot M, Rubin RR, Lauritzen T, Snoek FJ, Matthews DR, Skovlund SE. Psychosocial problems and barriers to improved diabetes management: results of the Cross-National Diabetes Attitudes, Wishes and Needs (DAWN) Study. Diabetic Medicine. 2005;22:1379–1385. doi: 10.1111/j.1464-5491.2005.01644.x.
    1. Cochran J, Conn VS. Meta-analysis of Quality of Life Outcomes Following Diabetes Self-management Training. The Diabetes Educator. 2008;34:815–823. doi: 10.1177/0145721708323640.
    1. Steed L, Cooke D, Newman S. A systematic review of psychosocial outcomes following education, self-management and psychological interventions in diabetes mellitus. Patient Educ Couns. 2003;51:5–15. doi: 10.1016/S0738-3991(02)00213-6.
    1. Knight KM, Dornan T, Bundy C. The diabetes educator: trying hard, but must concentrate more on behaviour. Diabetic Medicine. 2006;23:485–501. doi: 10.1111/j.1464-5491.2005.01802.x.
    1. Steinsbekk A, Rygg LO, Lisulo M, Rise MB, Fretheim A. Group based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus. A systematic review with meta-analysis. BMC Health Serv Res. 2012;12:213. doi: 10.1186/1472-6963-12-213.
    1. Rosal MC, Olendzki B, Reed GW, Gumieniak O, Scavron J, Ockene I. Diabetes self-management among low-income Spanish-speaking patients: a pilot study. Ann Behav Med. 2005;29:225–235. doi: 10.1207/s15324796abm2903_9.
    1. Wattana C, Srisuphan W, Pothiban L, Upchurch SL. Effects of a diabetes self-management program on glycemic control, coronary heart disease risk, and quality of life among Thai patients with type 2 diabetes. Nurs Health Sci. 2007;9:135–141. doi: 10.1111/j.1442-2018.2007.00315.x.
    1. Deakin TA, Cade JE, Williams R, Greenwood DC. Structured patient education: the diabetes X-PERT Programme makes a difference. Diabetic Medicine. 2006;23:944–954. doi: 10.1111/j.1464-5491.2006.01906.x.
    1. Davies MJ, Heller S, Skinner TC, Campbell MJ, Carey ME, Cradock S, Dallosso HM, Daly H, Doherty Y, Eaton S, et al. Effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial. BMJ. 2008;336:491–495. doi: 10.1136/.
    1. Sperl-Hillen J, Beaton S, Fernandes O, Von Worley A, Vazquez-Benitez G, Parker E, Hanson A, Lavin-Tompkins J, Glasrud P, Davis H, et al. Comparative effectiveness of patient education methods for type 2 diabetes: a randomized controlled trial. Archives of internal medicine. 2011;171:2001–2010. doi: 10.1001/archinternmed.2011.507.
    1. Pottie K, Hadi A, Chen J, Welch V, Hawthorne K. Realist review to understand the efficacy of culturally appropriate diabetes education programmes. Diabetic Medicine. 2013;30:1017–1025. doi: 10.1111/dme.12188.
    1. Loveman E, Cave C, Green C, Royle P, Dunn N, Waugh N. The clinical and cost-effectiveness of patient education models for diabetes: a systematic review and economic evaluation. Health Technol Assess. 2003;7:iii. doi: 10.3310/hta7220.
    1. Gillett M, Dallosso HM, Dixon S, Brennan A, Carey ME, Campbell MJ, Heller S, Khunti K, Skinner TC, Davies MJ. Delivering the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cost effectiveness analysis. BMJ. 2010;341:c4093. doi: 10.1136/bmj.c4093.
    1. Wong CKH, Wong WCW, Lam CLK, Wan YF, Wong WHT, Chung KL, Dai D, Tsui ELH, Fong DYT. Effects of Patient Empowerment Programme (PEP) on Clinical Outcomes and Health service Utilization in Type 2 Diabetes Mellitus in Primary Care: An Observational Matched Cohort Study. PLOS One. 2014;9:e95328. doi: 10.1371/journal.pone.0095328.
    1. Wong CKH, Wong WCW, Wan YF, Chan AKC, Chung KL, Chan FWC, Lam CLK. Patient Empowerment Programme in Primary Care Reduced All-cause Mortality and Cardiovascular Diseases in Patients with Type 2 Diabetes Mellitus: A Population-based Propensity-Matched Cohort Study. Diabetes, Obesity and Metabolism. 2015;17:128–135. doi: 10.1111/dom.12397.
    1. Wong CKH, Wong WCW, Wan YF, Chan AKC, Chan FWC, Lam CLK. Patient Empowerment Programme (PEP) and Risk of Microvascular Diseases among Patients with Type 2 Diabetes Mellitus in Primary Care: A Population-based Propensity Matched Cohort Study. Diabetes Care. 2015;38:e116–117. doi: 10.2337/dc14-2213.
    1. Wong CKH, Wong WCW, Wan YF, Chan AKC, Chan FWC, Lam CLK: Effect of a Structured Diabetes Education Program in Primary Care on Hospitalizations and Emergency Department Visits among Type 2 Diabetes Mellitus: Results from the Patient Empowerment Programme (PEP). Diabetic Medicine 2015, In Press.
    1. Lam CLK, Tse EYY, Gandek B. Is the standard SF-12 Health Survey valid and equivalent for a Chinese population? Quality of Life Research. 2005;14:539–547. doi: 10.1007/s11136-004-0704-3.
    1. Lam CLK, Wong CKH, Lam ETP, Lo YYC, Huang WW. Population Norm of Chinese (HK) SF-12 Health Survey_Version 2 of Chinese Adults in Hong Kong. Hong Kong Practitioner. 2010;32:77–86.
    1. Wong CKH, Lo YYC, Wong WHT, Fung CSC. The associations of body mass index with physical and mental aspects of health-related quality of life in Chinese patients with type 2 diabetes mellitus: results from a cross-sectional survey. Health and Quality of Life Outcomes. 2013;11:142. doi: 10.1186/1477-7525-11-142.
    1. Neumann PJ, Goldie SJ, Weinstein MC. Preference-Based Measures in Economic Evaluation in Health Care. Annual Review of Public Health. 2000;21:587–611. doi: 10.1146/annurev.publhealth.21.1.587.
    1. Brazier JE, Roberts J. The Estimation of a Preference-Based Measure of Health From the SF-12. Medical Care. 2004;42:851–859. doi: 10.1097/01.mlr.0000135827.18610.0d.
    1. Wong CKH, Lam ETP, Lam CLK. Comparison of direct-measured and derived short form six dimensions (SF-6D) health preference values among chronic hepatitis B patients. Quality of Life Research. 2013;22:2973–2981. doi: 10.1007/s11136-013-0403-z.
    1. Lam CLK, Brazier J, McGhee SM. Valuation of the SF-6D Health States Is Feasible, Acceptable, Reliable, and Valid in a Chinese Population. Value in Health. 2008;11:295–303. doi: 10.1111/j.1524-4733.2007.00233.x.
    1. McGhee SM, Brazier J, Lam CLK, Wong LC, Chau J, Cheung A, Ho A. Quality-adjusted life years: population-specific measurement of the quality component. Hong Kong Medical Journal. 2011;17(Suppl 6):s17–21.
    1. Walters S, Brazier J. What is the relationship between the minimally important difference and health state utility values? The case of the SF-6D. Health and Quality of Life Outcomes. 2003;1:4. doi: 10.1186/1477-7525-1-4.
    1. Vadstrup ES, Frølich A, Perrild H, Borg E, Røder M. Lifestyle intervention by group-based rehabilitation versus individual counseling in type 2 diabetes: 1-year follow-up of the Copenhagen type 2 diabetes rehabilitation project. Journal of Diabetes Mellitus. 2012;2:308–315. doi: 10.4236/jdm.2012.23048.
    1. Vadstrup ES, Frolich A, Perrild H, Borg E, Roder M. Health-related quality of life and self-related health in patients with type 2 diabetes: effects of group-based rehabilitation versus individual counselling. Health and Quality of Life Outcomes. 2011;9:110. doi: 10.1186/1477-7525-9-110.
    1. Khunti K, Gray LJ, Skinner T, Carey ME, Realf K, Dallosso H, Fisher H, Campbell M, Heller S, Davies MJ. Effectiveness of a diabetes education and self management programme (DESMOND) for people with newly diagnosed type 2 diabetes mellitus: three year follow-up of a cluster randomised controlled trial in primary care. BMJ. 2012;344:e2333. doi: 10.1136/bmj.e2333.
    1. Trento M, Gamba S, Gentile L, Grassi G, Miselli V, Morone G, Passera P, Tonutti L, Tomalino M, Bondonio P, et al. Rethink Organization to iMprove Education and Outcomes (ROMEO): a multicenter randomized trial of lifestyle intervention by group care to manage type 2 diabetes. Diabetes Care. 2010;33:745–747. doi: 10.2337/dc09-2024.
    1. Fan L, Sidani S. Effectiveness of diabetes self-management education intervention elements: A meta-analysis. Canadian Journal of Diabetes. 2009;33:18–26. doi: 10.1016/S1499-2671(09)31005-9.
    1. Fisher EB, Boothroyd RI, Coufal MM, Baumann LC, Mbanya JC, Rotheram-Borus MJ, Sanguanprasit B, Tanasugarn C. Peer Support For Self-Management Of Diabetes Improved Outcomes In International Settings. Health Affairs. 2012;31:130–139. doi: 10.1377/hlthaff.2011.0914.
    1. Carey ME, Mandalia PK, Daly H, Gray LJ, Hale R, Martin Stacey L, Taub N, Skinner TC, Stone M, Heller S, et al. Increasing capacity to deliver diabetes self-management education: results of the DESMOND lay educator non-randomized controlled equivalence trial. Diabetic Medicine. 2014;31:1431–1438. doi: 10.1111/dme.12483.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する