Yonsei Med J.  2015 Jan;56(1):244-252. 10.3349/ymj.2015.56.1.244.

Effects of Diabetic Case Management on Knowledge, Self-Management Abilities, Health Behaviors, and Health Service Utilization for Diabetes in Korea

• Shin SA
• Kim H
• Lee K
• Lin V
• Liu G
• Shin E

• KMID: 2352813
• DOI: http://doi.org/10.3349/ymj.2015.56.1.244

Abstract

PURPOSE
This study aimed to evaluate the effects of a case management program for diabetics, using a pre-post comparison design.
MATERIALS AND METHODS
The study population comprised 6007 diabetics who received case management intervention in 2006 and were sampled nationwide in Korea. Before and after the intervention, the study population answered questions regarding their knowledge of diabetes, self-management ability, and health behaviors. Body mass index (BMI) was also calculated. Healthcare service utilization for diabetes was extracted from health insurance claim data from 2005 to 2007.
RESULTS
The case management program significantly improved the study population's knowledge of diabetes and ability to self-manage nutrition, blood glucose monitoring, foot and oral care, and medications. This program also significantly changed the study population's health behaviors regarding smoking, alcohol drinking, and exercise, and BMI was positively affected. In the over-serviced subgroup, there was a significant decrease in the number of consultations (mean=7.0; SD=19.5) after intervention. Conversely, in the under-serviced subgroup, there was a significant increase in the number of consultations (mean=3.2; SD=7.9) and the days of prescribed medication (mean=66.4; SD=120.3) after intervention.
CONCLUSION
This study showed that the case management program led the study population to improve their knowledge, self-management ability, health behaviors, and utilization of health care. It is necessary in future studies to evaluate the appropriateness of healthcare usage and clinical outcome by using a control group to determine the direct effectiveness of this case management program.

Keyword

Case management; diabetes; intervention; Korea

MeSH Terms

Adult
Aged
Body Mass Index
*Case Management
Diabetes Mellitus/*therapy
Female
*Health Behavior
*Health Knowledge, Attitudes, Practice
Health Services/*utilization
Humans
Male
Middle Aged
Republic of Korea
*Self Care

Figure

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  Fig. 1 Distribution of body mass index at baseline and after intervention for males. There was a statistical significance between the two intervals in the McNemar test (χ2=78.62; df=10; p<0.001; n=2752).

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  Fig. 2 Distribution of body mass index at baseline and after intervention for females. There was a statistical significance between the two intervals in the McNemar test (χ2=132.23; df=10; p<0.001; n=3236).

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