Effectiveness of an Interprofessional Program (Siscare) for Supporting Patients With Type 2 Diabetes

Objective. To assess the effectiveness of an interprofessional support program (Siscare) that includes motivational interviews (patient-pharmacist), electronic monitoring (EM of medications, patient-reported and clinical outcomes monitoring, and interactions with physicians for patients with type 2 diabetes in French-speaking Switzerland. Methods. This was a prospective, multicenter, observational cohort study using a hybrid implementation-effectiveness design. Individual daily adherence to at least one oral antidiabetic medication was measured by EM. A global adherence score was estimated by the product of a model-estimated implementation and a nonparametric estimate of persistence over time. Clinical outcomes (A1C, blood glucose, BMI, blood pressure, heart rate, and cholesterol levels) and quality of life QoL were analyzed over time using linear mixed-effect models. Results. A total of 212 patients were included from 27 pharmacies; 120 patients (57%) were followed up for at least 15 months. In total, 140 patients (66%) were male, the mean age was 64 ± 11 years, and the mean number of chronic medications per patient at baseline was 5 ± 3. Of 178 patients who used EM, 95% (95% CI 92–99%) remained persistent at the end of the follow-up period. The percentage of persistent patients taking their medications appropriately (implementation) was stable during follow-up and was estimated to be 90% (95% CI 87–92%) at baseline and 88% (95% CI: 84–91%) at month 15. At baseline, the mean A1C and BMI were 7.5% and 31 kg/m2, respectively, which decreased by 0.5% (P = 0.012) and 0.6 kg/m2 (P = 0.017), respectively, after 15 months. QoL remained stable during follow-up. Conclusion. The program supports medication adherence and improves clinical outcomes, illustrating the overall preventive effect of coordinated care.</p

Associations of several factors about complementary medicine with respondents’ characteristics, stratified by gender and profession.

<p>Associations of several factors about complementary medicine with respondents’ characteristics, stratified by gender and profession.</p

Association of several factors with trained vs. non-trained healthcare professionals.

<p>Association of several factors with trained vs. non-trained healthcare professionals.</p

Sociodemographics.

<p>Sociodemographics.</p

Correlation between the plasma levels of Gas6 and those of other biomarkers.

<p>Correlation between the plasma levels of Gas6 and those of other biomarkers.</p

Receiver operator characteristic curve analysis of blood parameters for death in the ICU.

<p>The value of the Area Under the Curve for each blood parameter and the 95% confidence intervals are listed on the bottom right of the figure. APACHE II = Acute Physiology and Chronic Health Evaluation II, IL = Interleukin, SOFA = Sequential Organ Failure Assessment.</p

Performance of different biomarkers to predict mortality based on ROC curve area.

<p>Performance of different biomarkers to predict mortality based on ROC curve area.</p

Flow diagram of patients included in the study.

<p>Flow diagram of patients included in the study.</p

Survival curves of patients with sepsis with or without shock.

<p>Using Kaplan-Meier curves, stratified by Gas6 measurement at admission with a cut-off value of 249% (relative to Gas6 concentration in normal plasma) (<i>P</i> = 0.026, Log-rank test).</p

Patient characteristics by survival status.

<p>Patient characteristics by survival status.</p