Health Policy Manag.  2023 Mar;33(1):3-18. 10.4332/KJHPA.2023.33.1.3.

Effect of Community-Based Interventions for Registering and Managing Diabetes Patients in Rural Areas of Korea: Focusing on Medication Adherence by Difference in Difference Regression Analysis

• Son HR
• Park SY
• Yong HJ
• Chae SH
• Kim EJ
• Won ES
• Kim Y
• Bae SJ
• Kim CB

• KMID: 2549082
• DOI: http://doi.org/10.4332/KJHPA.2023.33.1.3

Abstract

Background
A chronic disease management program including patient education, recall and remind service, and reduction of out-of-pocket payment was implemented in Korea through a chronic care model. This study aimed to assess the effect of a community-based intervention program for improving medication adherence of patients with diabetes mellitus in rural areas of Korea.
Methods
We applied a non-equivalent control group design using Korean National Health Insurance Big Data. Hongcheon County has been continuously adopting this program since 2012 as an intervention region. Hoengseong County did not adopt such program. It was used as a control region. Subjects were a cohort of patients with diabetes mellitus aged more than 65 years but less than 85 years among residents for 11 years from 2010 to 2020. After 1:1 matching, there were 368 subjects in the intervention region and 368 in the control region. Indirect indicators were analyzed using the difference-in-difference regression according to Andersen’s medical use model.
Results
The increasing percent point of diabetic patients who continuously received insurance benefits for more than 240 days from 2010 to 2014 and from 2010 to 2020 were 2.6%p and 2.7%p in the intervention region and 3.0%p and 3.9%p in the control region, respectively. The number of dispensations per prescription of diabetic patient in the intervention region increased by approximately 4.61% by month compared to that in the control region.
Conclusion
The intervention program encouraged older people with diabetes mellitus to receive continuous care for overcoming the rule of halves in the community. More research is needed to determine whether further improvement in the continuity of comprehensive care can prevent the progression of cardiovascular diseases.

Keyword

Diabetes mellitus; Medication adherence; Community-based intervention; Difference-in-difference analysis