A preliminary evaluation of a disease management programme for patients with diabetes mellitus and hypertension in a primary healthcare setting

Ann Acad Med Singap. 2002 Jul;31(4):431-9.

Abstract

Introduction: The Comprehensive Chronic Care Programme (CCCP) is an intensified programme designed to provide comprehensive care for the management of diabetes mellitus, hypertension and hyperlipidaemia at a primary healthcare setting. A formative study was done to evaluate the effectiveness of the CCCP compared to the normal polyclinic management of diabetes mellitus.

Materials and methods: Control of diabetes (HbA1c) and hypertension (blood pressure) in 63 diabetic patients of a pilot CCCP was compared with 100 diabetic patients not on the programme (non-CCCP) after a 6-month follow-up. Paired t-tests were conducted for differences in mean HbA1c values between baseline and after 6 months. The H-rank test was applied to check for significant differences in change categories of hypertension control between CCCP and non-CCCP cases.

Results: In the CCCP group, there was a two-point decrease in HbA1c after 6 months and 65.1% of the patients showed improvement. The proportion of patients achieving optimal diabetic control increased from 9.5% to 36.5%. Conversely, there was deterioration in the non-CCCP group with decrease in the proportion of patients achieving optimal diabetic control from 31% to 21%. Of the hypertensive patients in the CCCP group, 54.5% showed an improvement in blood pressure (BP) control while 44% of the non-CCCP group showed improvement at 6 months.

Conclusions: CCCP, a comprehensive chronic disease management programme, is effective for good diabetic control of patients with diabetes mellitus.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Chronic Disease
  • Comprehensive Health Care / organization & administration*
  • Diabetes Mellitus / therapy*
  • Disease Management*
  • Female
  • Follow-Up Studies
  • Humans
  • Hypertension / therapy*
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Primary Health Care / organization & administration*
  • Program Evaluation*
  • Time Factors