Determinants of hospitalization in Chinese patients with type 2 diabetes receiving a peer support intervention and JADE integrated care: the PEARL randomised controlled trial
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AbstractBackground:
In a randomized controlled trial of 628 Chinese patients with type 2 diabetes receiving multidisciplinary care in the Joint Asia Diabetes Evaluation (JADE) Progam, 372 were randomized to receive additional telephone-based peer support (Peer Empowerment And Remote communication Linked by information technology, PEARL) intervention.
After 12 months, all-cause hospitalization was reduced by half in the PEARL group especially in those with high
Depression Anxiety and Stress Scale (DASS) scores.

Methods:
We used stratified analyses, negative binomial regression, and structural equation modelling (SEM) to examine
the inter-relationships between emotions, self-management, cardiometabolic risk factors, and hospitalization.

Results:
Hospitalized patients were older, more likely to have heart or kidney disease, and negative emotions than those without hospitalization. Patients with high DASS score who did not receive peer support had the highest hospitalization rates. After adjustment for confounders, peer support reduced the frequency of hospitalizations by
48% with a relative risk of 0.52 (95% CI 0·35–0·79;p = 0·0018). Using SEM, improvement of negative emotions
reduced treatment nonadherence (Est = 0.240, p = 0.034) and hospitalizations (Est=−0.218, p = 0.001). The latter
was also reduced by an interactive term of peer support and chronic kidney disease (Est = 0.833, p = < 0.001) and
that of peer support and heart disease (Est = 0.455, p = 0.001).

Conclusions:
In type 2 diabetes, improvement of negative emotions and peer support reduced hospitalizations, especially in those with comorbidities, in part mediated through improving treatment nonadherence. Integrating peer support is feasible and adds value to multidisciplinary care, augmented by information technology, especially in patients with comorbidities.

Trial registration: NCT00950716 Registered July 31, 2009.
Acceptance Date20/02/2018
All Author(s) ListYeung RO, Cai JH, Zhang Y, Luk AO, Pan JH, Yin J, Ozaki R, Kong APS, Ma R, So WY, Tsang CC, Lau KP, Fisher E, Goggins W, Oldenburg B, Chan J
Journal nameClinical Diabetes and Endocrinology
Year2018
Volume Number4
Issue Number5
Pages1 - 11
ISSN2055-8260
LanguagesEnglish-United Kingdom
KeywordsStructural equation modelling, Quality improvement, Peer support, Integrated care, Hospitalizations, Negative emotions, Adherence

Last updated on 2020-27-09 at 01:12