Implementing elements of a context-adapted chronic care model to improve first-line diabetes care: effects on assessment of chronic illness care and glycaemic control among people with diabetes enrolled to the First-Line Diabetes Care (FiLDCare) Project in the Northern Philippines.

UNLABELLED: Aim The purpose of this study was to investigate the effects of implementing elements of a context-adapted chronic disease-care model (CACCM) in two local government primary healthcare units of a non-highly urbanized city and a rural municipality in the Philippines on Patients' Assessment of Chronic Illness Care (PACIC) and glycaemic control (HbA1c) of people with diabetes. BACKGROUND: Low-to-middle income countries like the Philippines are beset with rising prevalence of chronic conditions but their healthcare systems are still acute disease oriented. Attention towards improving care for chronic conditions particularly in primary healthcare is imperative and ways by which this can be done amidst resource constraints need to be explored. METHODS: A chronic care model was adapted based on the context of the Philippines. Selected elements (community sensitization, decision support, minor re-organization of health services, health service delivery-system re-design, and self-management education and support) were implemented. PACIC and HbA1c were measured before and one year after the start of implementation. Findings The improvements in the PACIC (median, from 3.2 to 3.5) as well as in four of the five subsets of the PACIC were statistically significant (P-values: PACIC=0.009; 'patient activation'=0.026; 'goal setting'=0.017; 'problem solving'<0.001; 'follow-up'<0.001). The decrease in HbA1c (median, from 7.7% to 6.9%) and the level of diabetes control of the project participants (increase of optimally controlled diabetes from 37.2% to 50.6%) were likewise significant (P<0.000 and P=0.014). A significantly higher rating of the post-implementation PACIC subsets 'problem solving' (P=0.027) and 'follow-up' (P=0.025) was noted among those participants whose HbA1c improved. The quality of chronic care in general and primary diabetes care in particular may be improved, as measured through the PACIC and glycaemic control, in resource-constrained settings applying selected elements of a CACCM and without causing much strain on an already-burdened healthcare system.

The performance of the Finnish Diabetes Risk Score, a modified Finnish Diabetes Risk Score and a simplified Finnish Diabetes Risk Score in community-based cross-sectional screening of undiagnosed type 2 diabetes in the Philippines.

AIM: The performance of the Finnish Diabetes Risk Score (FINDRISC) and 2 modifications in community screening for undiagnosed type 2 diabetes (UDD) in the Philippines was evaluated. METHODS: Active community-based screening for diabetes was conducted where FINDRISC assessment was done. Modified (modFINDRISC) and simplified (simpFINDRISC) versions were rendered based on Asian standards, study results, and local context. Diabetes was diagnosed through 2 separate blood glucose tests. Areas under the receiver operating characteristic curve (ROC-AUC) and statistics for diagnostic tests for FINDRISC and the modifications were analyzed. RESULTS: Complete data was collected from 1752 people aged 20-92; 8.6% tested positive for diabetes. ROC-AUC for UDD were 0.738 (FINDRISC), 0.743 (modFINDRISC) and 0.752 (simpFINDRISC). The differences between the FINDRISC and the modifications were not statistically significant (p=0.172). CONCLUSIONS: The performance of all 3 risk score calculators in the screening for UDD in the Philippines was good and may be useful in populations having similar characteristics. Considering the setting and resource constraints, the simpFINDRISC is preferred.