한 농촌 지역사회 기반 당뇨병 환자의 등록관리 중재의 효과: 투약순응도에 대한 이중차이분석을 중심으로

초록

Background: A chronic disease management program including patient education, recall and remind service, and reduction ofout-of-pocket payment was implemented in Korea through a chronic care model. This study aimed to assess the effect of acommunity-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 hasbeen continuously adopting this program since 2012 as an intervention region. Hoengseong County did not adopt such program. Itwas used as a control region. Subjects were a cohort of patients with diabetes mellitus aged more than 65 years but less than 85 yearsamong residents for 11 years from 2010 to 2020. After 1:1 matching, there were 368 subjects in the intervention region and 368 inthe control region. Indirect indicators were analyzed using the difference-in-difference regression according to Andersen’s medicaluse model. Results: The increasing percent point of diabetic patients who continuously received insurance benefits for more than 240 days from2010 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 approximately4.61% 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 therule of halves in the community. More research is needed to determine whether further improvement in the continuity ofcomprehensive care can prevent the progression of cardiovascular diseases.

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