Clinical outcomes of type 2 diabetic patients before and after attending Siriraj Continuity of Care clinic.

Journal of the Medical Association of Thailand = Chotmaihet thangphaet

PubMedID: 23590026

Kitpinyochai T, Paisansudhi S, Washirasaksiri C, Srivanichakorn W, Nopmaneejumruslers C, Chouriyagune C, Pandejpong D, Phisalprapa P. Clinical outcomes of type 2 diabetic patients before and after attending Siriraj Continuity of Care clinic. J Med Assoc Thai. 2013;96 Suppl 2S82-90.
BACKGROUND
Many diabetic patients did not receive proper medical care to achieve treatment goals based on clinical practice recommendations. Siriraj Continuity of Care clinic (CC clinic) has been established specifically for medical students and internal medicine residency training purpose since 2006. The training components in the teaching clinic might contribute to overall better outcomes for Type 2 diabetic patients comparing to regular service clinics.

OBJECTIVE
To evaluate the efficacy of Siriraj CC clinic curriculum on improving clinical outcomes of diabetic patients.

MATERIAL AND METHOD
The authors retrospectively reviewed medical records of type 2 diabetic patients who had been referred from regular service clinics of Siriraj Out-Patient Department (OPD) to CC clinic during 2007 to 2011. Clinical outcomes of these patients were compared: before vs. after entering CC clinic.

RESULTS
One hundred and eighty medical records were reviewed. The mean of HbA1c were 7.5 and 7.3 percent before and after entering CC clinic (p = 0.026). Comparing clinical outcomes before vs. after entering CC clinic, we found that the percentage of patients who had optimal BMI and who had achieved LDL goals were 16.3 vs. 21.6 (p = 0.021), and 56.7 vs. 73.1 (p = 0.001), respectively. The proportion of patients who received annual diabetic complication assessments were also higher after entering CC clinic: the percentage of patients who received examinations of the eye, had urine micro albumin checked, had been screened for diabetic foot were increased from 58.3 to 93.3 (p < 0.001), 35.6 to 83.9 (p < 0.001), and 6.7 to 91.1 (p < 0.001), respectively. Moreover there were more patients who received adult health care maintenance program including: cancer screening program (clinical breast examination, mammography, fecal occult blood test and pap smear) and immunization (influenza, diphtheria tetanus and pneumococcal vaccine) (p < 0.001) after entering CC clinic.

CONCLUSION
After entering CC clinic, diabetic patients had better clinical outcomes as well as received better screening and health care maintenance program comparing to regular service clinics. The focus training components in this clinic has played a major role on contributing the preferred clinical performance among medical students and internal medicine residents.