Clinical Outcomes of Type 2 Diabetic Patients Before and After Attending Siriraj Continuity of Care Clinic
Thitiporn Kitpinyochai MD*, Supalerg Paisansudhi MD*, Chaiwat Washirasaksiri MD*, Weerachai Srivanichakorn MD*, Cherdchai Nopmaneejumruslers MD*, Charoen Chouriyagune MD*, Denla Pandejpong MD*, Pochamana Phisalprapa MD*
Affiliation : * Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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.
Keywords : Efficacy, Continuity of care clinic, Diabetes mellitus type 2, Outcome-based curriculum
