Participative decentralization of diabetes care in Davao City (Philippines) according to the Chronic Care Model: a program evaluation

Diabetes Res Clin Pract. 2014 Apr;104(1):189-95. doi: 10.1016/j.diabres.2014.01.026. Epub 2014 Jan 28.

Abstract

Aim: To assess the effectiveness of the Diabetes Project in Davao City, Philippines, regarding diabetes care access, diabetes management and cardiovascular risk factors. The project was developed in accordance with the Chronic Care Model (CCM) framework.

Methods: A non-randomized cross-sectional survey was conducted in nine intervention and five control Barangays (villages). People with diabetes aged ≥20 years were interviewed using a structured questionnaire; height, weight, waist circumference, and blood pressure were measured; HbA1c was tested with a NSGP-certified point-of-care device. Logistic regression models were used to compare the two groups.

Results: The intervention group (n=503) scored better than the controls (n=136) on the following (OR, 95% CI): percentage of patients taking metformin (1.5, 1.0-2.2); and in the last 12 months: laboratory test for fasting blood sugar (1.6, 1.1-2.3), HbA1c (6.0, 2.4-15.1), lipid profile (1.7, 1.1-2.5), nutritionist visit (1.6, 1.0-2.5) and therapeutic education session (2.7, 1.8-4.0). Glycemic control (HbA1c<7%) was also better in the intervention Barangays (1.6, 1.0-2.4). There were no statistical differences between the two groups for number of visits, and levels of other cardiovascular risk factors.

Conclusions: Our findings support the effectiveness of implementing the CCM framework in a low-to-middle income country on glycemic control and diabetes management.

Keywords: Chronic Care Model; Developing countries; Diabetes mellitus; Evaluation; Philippines.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Blood Glucose / metabolism
  • Blood Pressure Determination
  • Body Weight
  • Cross-Sectional Studies
  • Developing Countries
  • Diabetes Mellitus / blood
  • Diabetes Mellitus / epidemiology
  • Diabetes Mellitus / therapy*
  • Female
  • Humans
  • Long-Term Care / methods*
  • Male
  • Middle Aged
  • Philippines / epidemiology
  • Politics*
  • Prevalence
  • Program Evaluation*
  • Retrospective Studies
  • Risk Factors
  • Surveys and Questionnaires
  • Young Adult

Substances

  • Blood Glucose