The Effectiveness of Holistic Diabetic Management between Siriraj Continuity of Care Clinic and Medical Out-Patient Department
Chalobol Chalermsri MD*, Supalerg Paisansudhi MD*, Pitchaporn Kantachuvesiri MD*, Pornpoj Pramyothin MD**, Chaiwat Washirasaksiri MD*, Weerachai Srivanichakorn MD*, Cherdchai Nopmaneejumruslers MD*, Charoen Chouriyagune MD*, Denla Pandejpong MD*, Pochamana Phisalprapa MD*
Affiliation : * Division of Ambulatory Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Division of Nutrition, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Diabetes mellitus is one of the most common diseases in the Thai population, and it is well known that diabetic
complications could be prevented with appropriate management. Despite published guidelines, most Thai patients with
diabetes do not achieve treatment goals. Siriraj Continuity of Care clinic (CC clinic) was recently established in order to
provide training for medical students and internal medicine residents. It is possible that the training component in the CC
clinic may contribute to better overall outcomes in type 2 diabetes mellitus (type 2 DM) patients when compared with usual
care at the medical out-patient department (OPD).
Objective : To compare the effectiveness of diabetic management in type 2 diabetes mellitus patients who attended the CC clinic
and the medical OPD.
Material and Method: Retrospective chart review was performed in type 2 diabetes mellitus patients who were treated at
either clinic at Siriraj Hospital in 2007-2011. Baseline demographics, treatment strategies and outcomes, and participation
in an appropriate health maintenance program were assessed in both groups.
Results : Seven hundred and fifty seven medical records were reviewed, including 383 patients in the CC clinic group and 374
in the OPD group. Mean HbA1c was significantly lower in the CC clinic group compared with the OPD group (7.3+0.9% and
7.8+1.3%, respectively, p<0.001). The number of patients who achieved goal HbA1c of less than 7% in CC clinic group was
123 (32.1%) compared with 91 (24.3%) in the OPD group (p = 0.039). More patients were screened for diabetic complications
in the CC clinic group compared with the OPD group, including screening for diabetic neuropathy (57.4% vs. 2.1%,
p<0.001), diabetic retinopathy (56.7% vs. 36.6%, p<0.001), and diabetic nephropathy (80.9% vs. 36.9%, p<0.001).
Patients in the CC clinic group had a higher rate of age-appropriate cancer screening than those in the OPD group (54.2%
vs. 13.3%, p<0.001 for breast cancer; 24.0% vs. 0.9%, p<0.001 for cervical cancer; and 23.0% vs. 7.4%, p<0.001 for
colon cancer). Moreover, significantly more patients in the CC clinic group received recommended immunization (influenza,
diphtheria tetanus and pneumococcal vaccine) compared with the control group (p<0.001).
Conclusion : Diabetic patients treated at the CC clinic had better clinical outcomes and healthcare maintenance compared
with those who received usual care at the medical OPD. Continuity of care and integrated training component may have
contributed to the improved outcomes.
Keywords : Effectiveness, Continuity of care clinic, Diabetes mellitus
