The Effectiveness of Enhanced Primary Healthcare (EnPHC) interventions on Type 2 diabetes management in Malaysia: Difference-in-differences (DID) analysis

Husin M 1 , Teh XR 2 , Ong SM 2 , Lim YMF 2 , Ang SH 2 , Chan CL 2 Show all authors , Lim MT 2 , Shanmugam S 3 , Khamis N 3 , Jaafar FSA 3 , Ibrahim NI 4 , Nasir NH 4 , Kusuma D 5 , Wagner AK 6 , Ross-Degnan D 6 , Atun R 7 , Sivasampu S 2

Affiliations 

  • 1 Institute for Clinical Research, National Institutes of Health, Ministry of Health, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170 Shah Alam, Selangor, Malaysia. Electronic address: masliyana@crc.gov.my
  • 2 Institute for Clinical Research, National Institutes of Health, Ministry of Health, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170 Shah Alam, Selangor, Malaysia
  • 3 Institute for Health Management, National Institutes of Health, Ministry of Health, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170 Shah Alam, Selangor, Malaysia
  • 4 Family Health Development Division, Ministry of Health Malaysia, Kompleks E, Pusat Pentadbiran Kerajaan Persekutuan, 62590 Putrajaya, Malaysia
  • 5 Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States; Department of Health Services Research and Management, School of Health & Psychological Sciences, City University of London, London, United Kingdom
  • 6 Harvard Medical School and Harvard Pilgrim Health Care Institute, Landmark Center, 401 Park Dr #401, Boston, MA 02215, United States
  • 7 Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States
Prim Care Diabetes, 2023 Jun;17(3):260-266.
PMID: 36932012 DOI: 10.1016/j.pcd.2023.03.003

Abstract

AIMS: To evaluate the effectiveness of the Enhanced Primary Healthcare (EnPHC) interventions on process of care and intermediate clinical outcomes among type 2 diabetes patients.

METHODS: This was a quasi-experimental controlled study conducted in 20 intervention and 20 control public primary care clinics in Malaysia from November 2016 to June 2019. Type 2 diabetes patients aged 30 years and above were selected via systematic random sampling. Outcomes include process of care and intermediate clinical outcomes. Difference-in-differences analyses was conducted.

RESULTS: We reviewed 12,017 medical records of patients with type 2 diabetes. Seven process of care measures improved: HbA1c tests (odds ratio (OR) 3.31, 95% CI 2.13, 5.13); lipid test (OR 4.59, 95% CI 2.64, 7.97), LDL (OR 4.33, 95% CI 2.16, 8.70), and urine albumin (OR 1.99, 95% CI 1.12, 3.55) tests; BMI measured (OR 15.80, 95% CI 4.78, 52.24); cardiovascular risk assessment (OR 174.65, 95% CI 16.84, 1810.80); and exercise counselling (OR 1.18, 95% CI 1.04, 1.33). We found no statistically significant changes in intermediate clinical outcomes (i.e. HbA1c, LDL, HDL and BP control).

CONCLUSIONS: EnPHC interventions was successful in enhancing the quality of care, in terms of process of care, by changing healthcare providers behaviour.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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