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Effectiveness of a multidisciplinary risk assessment and management programme—diabetes mellitus (RAMP-DM) on patient-reported outcomes

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Abstract

Little is known about how the patient-reported outcomes is influenced by multidisciplinary-risk-assessment-and-management-programme for patients with diabetes mellitus (RAMP-DM). This paper aims to evaluate the effectiveness of RAMP-DM on patient-reported outcomes. This was a prospective longitudinal study on 1039 diabetes mellitus patients (714/325 RAMP-DM/non-RAMP-DM) managed in primary care setting. 536 and 402 RAMP-DM participants, and 237 and 187 non-RAMP-DM participants were followed up at 12 and 24 months with completed survey, respectively. Patient-reported outcomes included health-related quality of life, change in global health condition and patient enablement measured by Short Form-12 Health Survey version-2 (SF-12v2), Global Rating Scale, Patient Enablement Instrument respectively. The effects of RAMP-DM on patient-reported outcomes were evaluated by mixed effect models. Subgroup analysis was performed by stratifying haemoglobin A1c (HbA1c) (optimal HbA1c < 7 % and suboptimal HbA1c ≥ 7 %). RAMP-DM with suboptimal HbA1c was associated with greater improvement in SF-12v2 physical component summary score at 12-month (coefficient:3.80; P-value < 0.05) and 24-month (coefficient:3.82;P-value < 0.05), more likely to feel more enabled at 12-month (odds ratio: 2.57; P-value < 0.05), and have improved in GRS at 24-month (odds ratio:4.05; P-value < 0.05) compared to non-RAMP-DM participants. However, there was no significant difference in patient-reported outcomes between RAMP-DM and non-RAMP-DM participants with optimal HbA1c. Participation in RAMP-DM is effective in improving physical component of HRQOL, Global Rating Scale and patient enablement among diabetes mellitus patients with suboptimal HbA1c, but not in those with optimal HbA1c. Patients with sub-optimal diabetes mellitus control should be the priority target population for RAMP-DM. This observational study design may have potential bias in the characteristics between groups, and randomized clinical trial is needed to confirm the results.

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Acknowledgments

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors would like to acknowledge the contributions of the multidisciplinary risk-stratification based diabetes mellitus management programme team at the Hospital Authority head office, chief of service in primary care and programme coordinator in each cluster and Statistics and Workforce Planning Department at the Hong Kong Hospital Authority.

Funding

This study was funded by the Hong Kong Hospital Authority (Ref. no: 8011014157) and Health Services Research Fund, Food and Health Bureau, HKSAR Commissioned Research on Enhanced Primary Care Study (Ref. no EPC-HKU-2).

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Authors and Affiliations

  1. Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau Clinic, 3/F., 161 Main Street, Ap Lei Chau, Hong Kong

    Eric Yuk Fai Wan, Colman Siu Cheung Fung, Carlos King Ho Wong, Fang Fang Jiao, Anca Ka Chun Chan, Karina Hiu Yen Chan & Cindy Lo Kuen Lam

  2. School of Nursing, The University of Hong Kong, 4/F William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong

    Edmond Pui Hang Choi

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  1. Eric Yuk Fai Wan
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Correspondence to Eric Yuk Fai Wan.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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ClinicalTrials.gov (NCT02034695)

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Wan, E.Y.F., Fung, C.S.C., Wong, C.K.H. et al. Effectiveness of a multidisciplinary risk assessment and management programme—diabetes mellitus (RAMP-DM) on patient-reported outcomes. Endocrine 55, 416–426 (2017). https://doi.org/10.1007/s12020-016-1124-1

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