Effectiveness of the Chronic Care Model on clinical outcomes among diabetic patients under the Chiangsaen contracting units for primary care, Chiangrai province.

Abstract

Diabetes is a major challenge for the Thai healthcare system and especially for the primary care providers.Therefore,  a  cluster-randomized  controlled  trial  was  conducted  to  evaluate  the  effectiveness  of  the Chronic Care Model (CCM) for the patients with diabetes mellitus type 2 on clinical outcomes in Chiangsaen district. One hundred and twenty-three patients with diabetes type 2 from seven primary care units (63 interventions,  60  controls)  were  recruited  in  June  2012.  The  model  mainly  consisting  of  health  personnel and patient education, standardized documentation and agreement on therapeutic goals, was implemented in interventions; while controls received usual care. The primary outcome measure was a change in Hemoglobin A1c (HbA1c) after six  months. The  results  demonstrated  that,  at  6-month  follow  up,  97.5%  of  patients  had  completed  data.  Thereductions  of  HbA1c  in  interventions  was  more  than  in  controls  significantly  (mean  difference  =  2.2%, p < 0.001). The reduction of fasting blood sugar (FBS) and low density lipoprotein (LDL) in interventions were  also  greater  than  in  controls  significantly  (mean  difference  =  31.85  mg/dl  for  FBS;  and  17.02  mg/dl for LDL, p  <  0.001).  Blood  pressure was not  significantly  reduced among  the  two study  groups. To conclude, implementing the CCM can attributable to Chiangsaen healthcare system that target HbA1c, FBS  and  LDL  of  the  patients.  However,  larger  and  long-term  trials  are  needed  to  further  determine  the effectiveness of this  intervention  for Thai  diabetes  patients.