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Randomized Controlled Trial
. 2020 Feb 18;10(1):2842.
doi: 10.1038/s41598-020-59588-x.

A cluster-randomized trial of the effectiveness of a triple-faceted intervention promoting adherence to primary care physician visits by diabetes patients

Mitsuhiko Noda  1   2 , Yasuaki Hayashino  3   4 , Katsuya Yamazaki  5   6 , Hikari Suzuki  5   7 , Atsushi Goto  8   9 , Masayuki Kato  10 , Kazuo Izumi  11 , Masashi Kobayashi  5   7
Affiliations
Randomized Controlled Trial

A cluster-randomized trial of the effectiveness of a triple-faceted intervention promoting adherence to primary care physician visits by diabetes patients

Mitsuhiko Noda et al. Sci Rep. .

Erratum in

Abstract

We aimed to assess whether a triple-faceted intervention program administered in the primary care setting could decrease the risk of insufficient adherence to primary care physician (PCP) appointments among this patient population. We conducted a cluster-randomized controlled study to assess the effects of a 1-year intervention. The primary outcome was insufficient adherence to regular PCP attendance for diabetes treatment, defined as failure to visit a PCP within 2 months of an original appointment date. The intervention consisted of mailing patient reminders of their PCP appointments, providing patients with health education aimed at lifestyle modification and benchmarking PCP procedures. Eleven municipal level district medical associations employing 192 PCPs were divided into two subregions for assignment to intervention and control clusters, with 971 and 1,265 patients assigned to the intervention and control groups, respectively. Primary outcome data were available for 2,200 patients. The intervention reduced insufficient adherence to regular PCP appointments by 63% (hazard ratio, 0.37; 95% confidence interval [CI], 0.23-0.58). In conclusion, a triple-faceted intervention program consisting of health education, appointment reminders, and physician benchmarking may decrease the risk of incomplete adherence to regular PCP appointments by diabetes patients.

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Conflict of interest statement

The authors have read the journal’s policy and have the following conflicts: Dr. Noda serves as a chairperson of the evaluation committee of the Evidence-based Practice Guideline for the Treatment of Diabetes in Japan edited by Japan Diabetes Society. He also served as a member of the editorial committee of the Treatment Guide for Diabetes in Japan edited by Japan Diabetes Society and the Health Japan 21 (the second term) plan development committee. Dr. Noda received honoraria from Taisho Toyama Pharmaceutical Co. Ltd, MSD K.K., Novo Nordisk Pharma Ltd, outside of the submitted work. Other authors declare no competing financial or non-financial interest.

Figures

Figure 1
Figure 1
Flow chart of study cluster enrollment and patient selection procedures. DMAs, district medical associations.
Figure 2
Figure 2
Kaplan–Meier estimates of insufficient adherence to primary care attendance by patients with diabetes. Solid line: control group; broken line: intervention group.
Figure 3
Figure 3
Effect of intervention on the primary outcome stratified according to the baseline characteristics. Black squares: point estimates of the hazard ratio; bars: confidence intervals. PAID, problem areas in diabetes scale.
See this image and copyright information in PMC

References

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