Chronic care model in primary care: can it improve health-related quality of life?

Figures & data

Figure 1 Flowchart of participants in the study.

Note: *Participants who successfully completed 6 months follow-up were included in the analysis.
Abbreviation: GP, general practitioner.

Table 1 Baseline demographics and clinical characteristics of participants in the study

Variable	Intervention group (n=468)	Usual care group (n=225)	P-value
Mean age (SD), years	47.4 (9.4)	50.1 (10.2)	0.001**
Sex, n (%)			0.163*
Male	286 (61.1)	125 (55.6)
Female	182 (38.9)	100 (44.4)
Race, n (%)			<0.001*
Malay	208 (44.4)	104 (46.2)
Chinese	119 (25.4)	82 (36.4)
Indian	125 (26.7)	38 (16.9)
Others	16 (3.5)	1 (0.5)
Employment status, n (%)			<0.001*
Employed	368 (78.6)	162 (72.0)
Jobless	11 (2.4)	1 (0.4)
Housewife	46 (9.8)	49 (21.8)
Retired	43 (9.2)	13 (5.8)
Education, n (%)			<0.001*
Primary	25 (5.3)	42 (18.7)
Secondary	208 (44.4)	116 (51.6)
Graduate and above	176 (37.6)	52 (23.1)
Illiterate	59 (12.6)	15 (6.7)
Disease status,*** n (%)
Hypertension	306 (65.4)	173 (76.9)	0.002*
Hyperlipidemia	268 (57.3)	104 (46.2)	0.006*
Diabetes	292 (62.4)	130 (57.8)	0.244*
Tobacco use, n (%)
Past	44 (9.4)	13 (5.8)	0.08*
Current	78 (16.7)	28 (12.4)
Never	346 (73.9)	184 (81.8)

Notes:

* P-values based upon χ² test;

** P-values based upon t-test;

*** percentage exceeds 100% as some patients had >1 disease state.

Table 2 Distribution of participants reporting moderate or severe problems in different dimensions and the EQ-5D index scores

	Baseline	End of study	P-value
Intervention group (n=468)
Mobility, n (%)	32 (6.8)	25 (5.3)	0.412*
Self-care, n (%)	3 (0.6)	0 (0)	0.249*
Usual activity, n (%)	21 (4.5)	17 (3.6)	0.514*
Pain/discomfort, n (%)	147 (31.4)	81 (17.3)	<0.001*
Anxiety/depression, n (%)	112 (23.9)	70 (15.0)	0.001*
EQ-5D index score, mean (SD)	0.92 (0.10)	0.95 (0.08)	<0.001**
EQ VAS, mean (SD)	70.74 (16.53)	76.81 (15.28)	<0.001**
Usual care group (n=225)
Mobility, n (%)	10 (4.4)	8 (3.6)	0.641*
Self-care, n (%)	0 (0)	0 (0)
Usual activity, n (%)	5 (2.2)	4 (1.8)	0.752*
Pain/discomfort, n (%)	43 (19.1)	41 (18.2)	0.810*
Anxiety/depression, n (%)	46 (20.4)	40 (17.8)	0.548*
EQ-5D index score, mean (SD)**	0.94 (0.09)	0.95 (0.09)	0.084*
EQ VAS, mean (SD)	70.72 (25.42)	72.35 (24.81)	0.314**

Notes:

Data are utility value 0–1 (mean [SD]), VAS scores 0–100 (mean [SD]), and number and percentage of patients reporting problems within the five dimensions.

* P-value based on χ² test;

** P-value based on paired t-test.

Abbreviations: EQ-5D, EuroQoL-five dimension, health-related quality of life questionnaire; EQ-VAS, EQ-5D visual analog scale.

Table 3 Patients with a minimum clinically significant change in outcome from baseline to 6 months

	Intervention group	Usual care group
Whole cohort
EQ-5D index score	n^†=468	n^†=225
Improving by > MIC, n* (%)	115 (24.6)	18 (8.0)
Worsening by > MIC, n* (%)	33 (7.1)	9 (4.0)
EQ-VAS score	n^†=460	n^†=223
Improving by > MIC, n* (%)	208 (45.2)	46 (20.6)
Worsening by > MIC, n* (%)	67 (14.6)	27 (12.1)
Hypertension
EQ-5D index score	n^†=306	n^†=173
Improving by > MIC, n* (%)	76 (24.8)	15 (8.7)
Worsening by > MIC, n* (%)	22 (7.2)	7 (4.0)
EQ-VAS score	n^†=302	n^†=172
Improving by > MIC, n* (%)	141 (46.7)	38 (22.1)
Worsening by > MIC, n* (%)	43 (14.2)	19 (11.0)
Diabetes mellitus
EQ-5D index score	n^†=306	n^†=173
Improving by > MIC, n* (%)	67 (25.0)	6 (5.8)
Worsening by > MIC, n* (%)	20 (7.5)	4 (3.8)
EQ-VAS score	n^†=262	n^†=104
Improving by > MIC, n* (%)	125 (47.7)	24 (23.1)
Worsening by > MIC, n* (%)	36 (13.7)	11 (10.6)
Hyperlipidemia
EQ-5D index score	n^†=233	n^†=106
Improving by > MIC, n* (%)	55 (23.6)	7 (6.6)
Worsening by > MIC, n* (%)	17 (7.3)	6 (5.7)
EQ-VAS score	n^†=230	n^†=104
Improving by > MIC, n* (%)	105 (45.7)	20 (19.2)
Worsening by > MIC, n* (%)	33 (14.3)	17 (16.3)

Notes:

MIC, minimally important change defined as 0.03 points in the EQ-5D index score and 3 points in the EQ-VAS score.

* These numbers represent the number of patients who attended final visit 6-month postintervention, and percentages are based on these numbers. The number of patients with data for each endpoint (n^†) is presented before each endpoint.

Abbreviations: EQ-5D, EuroQoL-five dimension, health-related quality of life questionnaire; EQ-VAS, EQ-5D visual analog scale.

Table 4 Results of the GEE regression analyses

Parameter	EQ-5D index score		EQ-VAS score
	Estimate (SE)	P-value	Estimate (SE)	P-value
Intercept	0.96 (0.04)	<0.01	65.74 (7.0)	<0.01
Allocation
CORFIS	−0.01 (0.01)	0.11	1.44 (1.7)	0.42
Usual care (reference)
Education status
Primary	0.01 (0.02)	0.64	−7.46 (4.1)	0.07
Secondary	0.01 (0.01)	0.48	−0.09 (2.4)	0.97
Tertiary	0.02 (0.01)	0.21	−1.19 (2.6)	0.64
Illiterate (reference)
Race
Malay	0.03 (0.02)	0.22	4.41 (4.0)	0.27
Chinese	0.02 (0.02)	0.50	3.76 (4.1)	0.36
Indian	−0.01 (0.02)	0.82	4.79 (4.2)	0.25
Others (reference)
Occupational status
Employed	0.00 (0.01)	0.99	−1.75 (3.3)	0.60
Housewife	−0.01 (0.02)	0.51	−3.39 (3.5)	0.34
Jobless	−0.02 (0.03)	0.48	−3.33 (5.1)	0.51
Retired (reference)
Age (years)	−0.00 (0.00)	0.12	0.09 (0.1)	0.25

Abbreviations: CORFIS, Community Based Multiple Risk Factors Intervention Strategy; EQ-5D, EuroQoL-five dimension, health-related quality of life questionnaire; EQ-VAS, EQ-5D visual analog scale; GEE, generalized estimating equation; SE, standard error.

Table 5 EQ-5D scores in hypertensive, diabetic, and hyperlipidemic patients

Disease	Hypertension		Diabetes		Hyperlipidemia
	Intervention group	Usual care group	Intervention group	Usual care group	Intervention group	Usual care group
EQ-5D index score	n=306	n=173	n=268	n=104	n=292	n=130
Baseline	0.93 (0.10)	0.94 (0.09)	0.92 (0.10)	0.94 (0.09)	0.93 (0.10)	0.95 (0.09)
End of study	0.95 (0.09)	0.95 (0.09)	0.95 (0.10)	0.94 (0.09)	0.96 (0.09)	0.95 (0.09)
P-value*	<0.001	0.082	<0.001	0.608	<0.001	0.513
EQ VAS score	n=302	n=131	n=262	n=81	n=288	n=96
Baseline	71.9 (16.5)	70.3 (25.8)	69.5 (17.2)	66.7 (27.2)	70.0 (16.5)	72.3 (25.8)
End of study	77.6 (14.8)	72.2 (25.8)	75.8 (15.9)	69.5 (26.6)	76.6 (15.1)	75.1 (22.7)
P-value*	<0.001	0.508	<0.001	0.488	<0.001	0.392

Notes:

* P-value based on paired t-test for within-group differences. EQ-5D scores were computed using the Malaysian index. Higher EQ-5D and EQ-VAS scores represent better quality of life.

Abbreviations: EQ-5D, EuroQoL-five dimension, health-related quality of life questionnaire; EQ VAS, EQ-5D visual analog scale.