Impact of a chronic care model based on patient empowerment on the management of type 2 diabetes: Effects of the SINERGIA program [Lavoro originale Impatto di un modello di cura delle patologie croniche basato sul patient empowerment per il controllo del diabete di tipo 2: Effetti del programma SINERGIA]
Musacchio N.,Responsabile Unita Operativa Integrazione Cure Primarie e Specialistiche |
Giancaterini A.,Responsabile Unita Operativa Integrazione Cure Primarie e Specialistiche |
Lovagnini Scher A.,Responsabile Unita Operativa Integrazione Cure Primarie e Specialistiche |
Errichelli C.,Responsabile Unita Operativa Integrazione Cure Primarie e Specialistiche |
And 6 more authors.
Giornale Italiano di Diabetologia e Metabolismo | Year: 2010
Several chronic care models for diabetes care have been implemented in Italy, but conclusive data on their effectiveness are lacking. In the diabetes clinic in Cusano Milanino, patients with type 2 diabetes not on insulin who had reached a stable metabolic control were included in a structured educational program called "SINERGIA". The approach is based on the empowerment of the patient and is managed by diabetologists, nurses, and dietitians. In the absence of acute events, the patient is his own "case manager", while the number of the face-to-face visits with the physician is reduced and telemedicine resources are utilized efficiently. We evaluated the efficacy of this approach by comparing some outcomes measured in the year before and after the initiation of the program. A generalized hierarchical linear regression model for repeated measures was used; a spatial-power covariance structure was specified to address the within-subject correlation and the unequally spaced time occasions. Overall, 1004 patients entered the program. Patients characteristics at baseline were the following (mean ± SD): age 66.6 ± 6.2 years, 54.1% males, diabetes duration 10.8 ± 7.7 years, BMI 29.5 ± 4.8 kg/m2, HbA1c 7.2 ± 1.1%; furthermore, 72.9% of the patients were treated with antihypertensive drugs and 32.7% were treated with lipid-lowering drugs. After a median follow-up of 12 months (range 6-24 months), the proportion of patients with HbA1c ≤ 7.0% increased from 32.7% to 45.8% (p < 0.0001), while the percentage of patients with HbA1c ≥ 9% decreased from 10.5% to 4.3% (p < 0.0001). The proportion of patients with LDL cholesterol < 100 mg/dl increased from 39.7% to 47.3% (p < 0.0001), while the percentage of patients with LDL ≥ 130 mg/dl decreased from 26.6% to 19.7%; blood pressure levels remained stable, although a small reduction in the percentage of patients with high levels was found. Improvements in these clinical parameters were obtained with a reduction in the mean number of face-to-face encounters from (median and range) 2.8 (2.3-3.4) to 2.3 (1.9-2.7) visits per patient/year. In conclusion, the SINERGIA model is effective on metabolic control and major cardiovascular risk factors, while reducing the workload for the diabetologist and allowing them to dedicate more time to more severe patients.