A Study of the Geographical Disparities in Diabetes Care in Taiwan

Autor: Hsiu-Chen Chen, 陳秀珍
Rok vydání: 2014
Druh dokumentu: 學位論文 ; thesis
Popis: 102
Background: The statistic report of the International Diabetes Foundation (IDF) estimated that the number of people with diabetes will reach to 592 million in year 2035 and 510 million will die from the disease. In 2013 this disease occurred approximately one death per six seconds. In Taiwan, the total population of diabetes is climbing up to 1,720,100 and the prevalence of diabetes is approximately 8.3%. Diabetes is the fifth leading death cause announced by the Ministry of Health and Welfare, Taiwan. A variety of complications are easily occurred by poor control of diabetes. Therefore, it is of importance to control the disease to prevent diabetic patients from having complications, including vascular disease and small vessel disease (such as retinopathy). For diabetic patients, they are also often comorbid with macrovascular disease, like ischemic heart disease and peripheral vascular disease too. Not only having good glycemic control in the procedure of treatment, how to well control of blood pressure and lipid should need to pay more attention. The Diabetes Shared Care Program (DSCP) centers in diabetes to provide patient examination, inspection, health education and complete tracking services to reduce or delay the complications associated with the occurrence and to improve quality of care. Objectives: The study focused to understand the effectiveness of care indicators on diabetic care and its impact of the care on the caring outcomes after the implementation of DSCP. In addition, whether the geographical disparities in the outcomes of DSCP existed or not was the other one of the study purposes. Methods: This research was a retrospective follow-up study. By extracted data from "Diabetes Care Network Information System" (DCNIS)" of a County Health Bureau located at central Taiwan, there were 4,959 diabetic patients having their two years case management continuously from 2009-2012. (ICD-10 -CM 250.XX). To comparison the geographical disparities in diabetic care program, the analyzed variables included blood glucose, blood pressure and blood lipids. The demographic characteristics, disease history and diabetes care indicators (including process indicators and outcome indicators of care) would be treated at outcome evaluation. Results: There were no significant difference among the eight living areas (Changhua-living area, Lukang-living area, Hemei-living area, Yuanlin-living area, Xihu-living area, Tianzhong-living area, Beidou-living area and Erlin-living area) for glycated hemoglobin and lipid testing rates at baseline (Lukang-living area as the reference group). There were significant difference among Yuanlin-living area, Changhua-living area and Hemei-living area after two years intervention follow up (Lukang-living as the reference group), the odds ratios were 1.72, 1.94 and 2.52 respectively. For retinal examination there were significant difference at baseline except Yuanlin-living area. Three living areas (Xihu-living area, Hemei-living area and Tianzhong-living area) remained significant difference after two years intervention follow up with odds ratio 0.52, 3.03 and 2.13 respectively. It indicated diabetes care intervention could reduce the differences between urban and rural areas for retinal examination. For Microalbumin test, Yuanlin-living area and Changhua-living area showed significant difference at baseline. However, after two years intervention follow up, Yuanlin-living area and Xihu-living area showed significant difference with odds ratio 0.26 and 2.14 respectively. For the ABC compliance rate of diabetes care at baseline, there was no significant difference (Xihu Township-living area as the reference group). After two years intervention follow up, the similar result was found no significant difference. At baseline and during follow up, variables (number of diabetes personnel educator per ten thousand population, farmers, duration of diabetes and Body Mass Index >24) were significantly related to ABC compliance rate. Family history of diabetes was related to ABC compliance rate only during follow up. Conclusion: In addition to medical resources, socio-demographic status and personal characteristics, there are differences still existing between urban and rural areas. The Diabetes Shared Care Program (DSCP) may have significant effects to reduce the gap on diabetes care, especially for retinal examination.
Databáze: Networked Digital Library of Theses & Dissertations
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