Evaluating A Multicomponent Chronic Disease Management Pilot Intervention among Korean Patients with Hypertension and Diabetes
Abstract
Background: A local clinic-based chronic disease management intervention including care planning, education about disease management, monitoring, and evaluation of the achievement of objects was introduced in Korea in 2019. We evaluated the effect of the intervention on medication adherence in patients with hypertension and diabetes.
Methods: In 2019, a one-year retrospective case-control group study design was performed using data from the National Health Insurance Service in Korea. Propensity score matching was used to control for selection bias. Medication adherence, calculated by medication possession rate, was the dependent variable. We conducted multivariate logistic regression analyses to examine the association between participation in the intervention and medication adherence, adjusting for covariates. A control group was set as a reference for participation in the full/partial component intervention.
Results: The proportions of participants in the full component intervention in the experimental group were 43.2% and 42.6% for patients with hypertension or diabetes, respectively. Both these groups tended to be more medication adherent than their counterparts (hypertension OR: 1.23, 95% CI 1.03-1.45, diabetes OR: 1.64, 95% CI: 1.24-2.17).
Conclusion: Institutionalizing a comprehensive chronic disease management program using multidisciplinary teams in the primary care context is crucial. Also, it is necessary to refine reimbursement payment systems.
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12. Choi YJ, Kim YT, Yi HS, et al (2021). Ef-fects of community-based interventions on medication adherence and hospitali-zation for elderly patients with type 2 diabetes at primary care clinics in South Korea. Int J Environ Res Public Health, 18:3396.
13. Sung NJ, Choi YJ, Lee JH (2018). Primary care comprehensiveness can reduce emergency department visits and hospi-talization in people with hypertension in South Korea. Int J Environ Res Public Health, 15:272.
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17. Dimatteo MR, Giordani PJ, Lepper HS, et al (2002). Patient adherence and medical treatment outcomes: a meta-analysis. Med Care, 40:794–811.
18. Kim JA, Kim ES, Lee EK (2017). Evaluation of the chronic disease management program for appropriateness of medi-cation adherence and persistence in hy-pertension and type-2 diabetes patients in Korea. Medicine (Baltimore), 96: e6577.
19. Andrade SE, Kahler KH, Frech F, et al (2006). Methods for evaluation of medi-cation adherence and persistence using automated databases. Pharmacoepidemiol Drug Saf, 15:565–74.
20. Hong JS, Kang HC (2011). Relationship be-tween oral antihypergliycemic medica-tion adherence and hospitalization, mortality, and healthcare costs in adult ambulatory care patients with type 2 di-abetes in South Korea. Med Care, 49:378–84.
21. Shin S, Song H, Oh SK, et al (2013). Effect of antiyhypertensive medication adher-ence on hospitalization for cardiovascu-lar disease and mortality in hypertensive patients. Hypertens Res, 36:1000–5.
22. Cramer JA, Benedict A, Muszbek N, et al (2008). The significance of compliance and persistence in the treatment of dia-betes, hypertension and dyslipidemia: a review. Int J Clin Pract, 62:76–87.
23. Karve S, Cleves MA, Helm M, et al (2008). An empirical basis for standardizing adherence measures derived from ad-ministrative claims data among diabetic patients. Med Care, 46:1125–33.
24. Halpern MT, Khan ZM, Schmier JK, et al (2006). Recommendations for evaluating compliance and persistence with hyper-tension therapy using retrospective data. Hypertension, 47:1039–48.
25. Karve S, Cleves MA, Helm M, et al (2009). Good and poor adherence: optimal cut-point for adherence measuring using administrative claims data. Curr Med Res Opin, 25:2303–10.
26. Hansen RA, Kim MM, Song L, et al (2009). Comparison of methods to assess med-ication adherence and classify non-adherence. Ann Pharmacother, 43:413–22.
27. Park JH, Shin Y, Lee SY, Lee SI (2008). Anti-hypertensive drug medication adher-ence and its affecting factors in South Korea. Int J Cardiol, 128:392–398.
28. Sung SK, Lee SG, Lee KS, et al (2009). First-year treatment adherence among outpa-tients initiating antihypertensive medica-tion in Korea: results of a retrospective claims review. Clin Ther, 31:1309–20.
29. Kim S, Shin DW, Yun J, et al (2016). Medica-tion adherence and the risk of cardio-vascular mortality and hospitalization among patients with newly prescribed antihypertensive medications. Hyperten-sion, 67:506–12.
30. Magid DJ, Ho PM, Olson KL, et al (2011). A multimodal blood pressure control in-tervention in 3 healthcare systems. Am J Manag Care, 17:e96–103.
31. Wu JR, Cummings DM, Li Q, et al (2018). The effect of a practice-based multi-component intervention that includes health coaching on medication adher-ence and blood pressure control in rural primary care. J Clin Hypertens (Greenwich), 20:757–64.
32. Viswanathan M, Golin CE, Jones CD, et al (2012). Interventions to improve adher-ence to self-administered medications for chronic diseases in the United States: a systematic review. Ann Intern Med, 157:785–95.
33. Conn VS, Ruppar TM, Chase JA, et al (2015). Interventions to improve medication adherence in hypertensive patients: sys-tematic review and meta-analysis. Curr Hypertens Rep, 17:94.
34. Mackey K, Parchman ML, Leykum LK, et al (2012). Impact of the chronic care mod-el on medication adherence when pa-tients perceive cost as barrier. Prim Care Diabetes, 6:137–42.
35. Asch DA, Troxel AB, Stewart WF, et al (2015). Effect of financial incentives to physicians, patients, or both on lipid levels: a randomized clinical trial. JAMA, 314:1926–35.
36. Wagner EH (2000). The role of patient care teams in chronic disease management. BMJ, 320:569-72.
37. Wagner EH, Austin BT, Davis C, et al (2001). Improving chronic illness care: translat-ing evidence into action. Health Aff (Millwood), 20:64–78.
38. Bodenheimer T, Wagner EH, Grumbach K (2002). Improving primary care for pa-tients with chronic illness: the chronic care model, part 2. JAMA, 288:1909–14.
39. Bodenheimer T, Ghorob A, Willard-Grace R, et al (2014). The 10 building blocks of high-performing primary care. Ann Fam Med, 12:166–71.
40. Kim JH, Lee WY, Hong YP, et al (2014). Psychometric properties of a short self-reported measure of medication adher-ence among patients with hypertension treated in a busy clinical setting in Ko-rea. J Epidemiol, 24:132–40.
41. Jimenez G, Matchar D, Koh GC, Car J (2020). Multicomponent interventions for enhancing primary care: a systemat-ic review. Br J Gen Pract, 71:e10–e21.
42. Kwon S (2003). Payment system reform for health care providers in Korea. Health Policy Plan, 18:84–92.
2. National Health Insurance Service (2020). 2019 Statistics of National Health Insurance. NHIS. Wonju.
3. Østbye T, Yarnall KSH, Krause KM, et al (2005). Is there time for management of patients with chronic diseases in prima-ry care? Ann Fam Med, 3:209–14.
4. Ministry of Health and Welfare, Korean Disease Control and Prevention Agency (2020). Korean Health Statistics 2019. Kore-an Health Statistics, KDCA. Cheongju.
5. Rijken M, Bekkema N, Boeckxstaens P, et al (2014). Chronic disease management programmes: an adequate response to patients’ needs? Health Expect, 17:608–21.
6. Reynolds R, Dennis, S, Hasan I, et al (2018). A systematic review of chronic disease management interventions in primary care. BMC Fam Pract, 19:11.
7. Rothman AA, Wagner EH (2003). Chronic illness management: what is the role of primary care? Ann Intern Med, 138:256–261.
8. Russell GM, Dahrouge S, Hogg W, et al (2009). Managing chronic disease in On-tario primary care: the impact of organ-izational factors. Ann Fam Med, 7:309–18.
9. Statistics of Korea (2021). Annual Report of Healthcare. Statistics of Korea. Sejong.
10. Lee JY, Eun SJ, Kim HJ, Jo M (2016). Find-ing the primary care providers in the specialist-dominant primary care setting of Korea: A cluster analysis. PLoS One, 11:e0161937.
11. Cho Y, Chung H, Joo H, et al (2020). Com-parison of patient perceptions of pri-mary care quality across healthcare fa-cilities in Korea: a cross-sectional study. PLoS One, 15:e0230034.
12. Choi YJ, Kim YT, Yi HS, et al (2021). Ef-fects of community-based interventions on medication adherence and hospitali-zation for elderly patients with type 2 diabetes at primary care clinics in South Korea. Int J Environ Res Public Health, 18:3396.
13. Sung NJ, Choi YJ, Lee JH (2018). Primary care comprehensiveness can reduce emergency department visits and hospi-talization in people with hypertension in South Korea. Int J Environ Res Public Health, 15:272.
14. Kim HS, Yoo B, Lee EW (2018). Evaluation of the national chronic diseases man-agement policy: performance and future directions. Public Health Aff, 2:105–20.
15. Ministry of Health and Welfare (2019). Guide of Primary Care Based Chronic Disease Management Pilot Program. MOHW. Sejong,
16. Song E, Kim Y, Ji S (2021). Impact of a primary health care chronic diseases management pilot program. Korean J Med, 96:7–12.
17. Dimatteo MR, Giordani PJ, Lepper HS, et al (2002). Patient adherence and medical treatment outcomes: a meta-analysis. Med Care, 40:794–811.
18. Kim JA, Kim ES, Lee EK (2017). Evaluation of the chronic disease management program for appropriateness of medi-cation adherence and persistence in hy-pertension and type-2 diabetes patients in Korea. Medicine (Baltimore), 96: e6577.
19. Andrade SE, Kahler KH, Frech F, et al (2006). Methods for evaluation of medi-cation adherence and persistence using automated databases. Pharmacoepidemiol Drug Saf, 15:565–74.
20. Hong JS, Kang HC (2011). Relationship be-tween oral antihypergliycemic medica-tion adherence and hospitalization, mortality, and healthcare costs in adult ambulatory care patients with type 2 di-abetes in South Korea. Med Care, 49:378–84.
21. Shin S, Song H, Oh SK, et al (2013). Effect of antiyhypertensive medication adher-ence on hospitalization for cardiovascu-lar disease and mortality in hypertensive patients. Hypertens Res, 36:1000–5.
22. Cramer JA, Benedict A, Muszbek N, et al (2008). The significance of compliance and persistence in the treatment of dia-betes, hypertension and dyslipidemia: a review. Int J Clin Pract, 62:76–87.
23. Karve S, Cleves MA, Helm M, et al (2008). An empirical basis for standardizing adherence measures derived from ad-ministrative claims data among diabetic patients. Med Care, 46:1125–33.
24. Halpern MT, Khan ZM, Schmier JK, et al (2006). Recommendations for evaluating compliance and persistence with hyper-tension therapy using retrospective data. Hypertension, 47:1039–48.
25. Karve S, Cleves MA, Helm M, et al (2009). Good and poor adherence: optimal cut-point for adherence measuring using administrative claims data. Curr Med Res Opin, 25:2303–10.
26. Hansen RA, Kim MM, Song L, et al (2009). Comparison of methods to assess med-ication adherence and classify non-adherence. Ann Pharmacother, 43:413–22.
27. Park JH, Shin Y, Lee SY, Lee SI (2008). Anti-hypertensive drug medication adher-ence and its affecting factors in South Korea. Int J Cardiol, 128:392–398.
28. Sung SK, Lee SG, Lee KS, et al (2009). First-year treatment adherence among outpa-tients initiating antihypertensive medica-tion in Korea: results of a retrospective claims review. Clin Ther, 31:1309–20.
29. Kim S, Shin DW, Yun J, et al (2016). Medica-tion adherence and the risk of cardio-vascular mortality and hospitalization among patients with newly prescribed antihypertensive medications. Hyperten-sion, 67:506–12.
30. Magid DJ, Ho PM, Olson KL, et al (2011). A multimodal blood pressure control in-tervention in 3 healthcare systems. Am J Manag Care, 17:e96–103.
31. Wu JR, Cummings DM, Li Q, et al (2018). The effect of a practice-based multi-component intervention that includes health coaching on medication adher-ence and blood pressure control in rural primary care. J Clin Hypertens (Greenwich), 20:757–64.
32. Viswanathan M, Golin CE, Jones CD, et al (2012). Interventions to improve adher-ence to self-administered medications for chronic diseases in the United States: a systematic review. Ann Intern Med, 157:785–95.
33. Conn VS, Ruppar TM, Chase JA, et al (2015). Interventions to improve medication adherence in hypertensive patients: sys-tematic review and meta-analysis. Curr Hypertens Rep, 17:94.
34. Mackey K, Parchman ML, Leykum LK, et al (2012). Impact of the chronic care mod-el on medication adherence when pa-tients perceive cost as barrier. Prim Care Diabetes, 6:137–42.
35. Asch DA, Troxel AB, Stewart WF, et al (2015). Effect of financial incentives to physicians, patients, or both on lipid levels: a randomized clinical trial. JAMA, 314:1926–35.
36. Wagner EH (2000). The role of patient care teams in chronic disease management. BMJ, 320:569-72.
37. Wagner EH, Austin BT, Davis C, et al (2001). Improving chronic illness care: translat-ing evidence into action. Health Aff (Millwood), 20:64–78.
38. Bodenheimer T, Wagner EH, Grumbach K (2002). Improving primary care for pa-tients with chronic illness: the chronic care model, part 2. JAMA, 288:1909–14.
39. Bodenheimer T, Ghorob A, Willard-Grace R, et al (2014). The 10 building blocks of high-performing primary care. Ann Fam Med, 12:166–71.
40. Kim JH, Lee WY, Hong YP, et al (2014). Psychometric properties of a short self-reported measure of medication adher-ence among patients with hypertension treated in a busy clinical setting in Ko-rea. J Epidemiol, 24:132–40.
41. Jimenez G, Matchar D, Koh GC, Car J (2020). Multicomponent interventions for enhancing primary care: a systemat-ic review. Br J Gen Pract, 71:e10–e21.
42. Kwon S (2003). Payment system reform for health care providers in Korea. Health Policy Plan, 18:84–92.
| Files | ||
| Issue | Vol 53 No 5 (2024) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v53i5.15586 | |
| Keywords | ||
| Primary care Hypertension Diabetes mellitus Medication adherence Patient education | ||
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How to Cite
1.
Bae MS, Song H. Evaluating A Multicomponent Chronic Disease Management Pilot Intervention among Korean Patients with Hypertension and Diabetes. Iran J Public Health. 2024;53(5):1058-1067.
