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Effectiveness of the EMPOWER-PAR intervention in improving clinical outcomes of type 2 diabetes mellitus in primary care: a pragmatic cluster randomised controlled trial


Ramli, Anis Safura and Selvarajah, Sharmini and Daud, Maryam Hannah and Haniff, Jamaiyah and Abdul Razak, Suraya and Tg Abu Bakar Sidik, Tg Mohd Ikhwan and Bujang, Mohamad Adam and Chew, Boon How and Rahman, Thuhairah and Tong, Seng Fah and Shafie, Asrul Akmal and Lee, Verna K. M. and Ng, Kien Keat and Ariffin, Farnaza and Abdul Hamid, Hasidah and Md Yasin, Mazapuspavina and Mat Nasir, Nafiza and Chan, Chun W. and Abdul Rahman, Yong Rafidah and Ismail, Mastura and Lakshmanan, Sharmila and Low, Wilson H. H. (2016) Effectiveness of the EMPOWER-PAR intervention in improving clinical outcomes of type 2 diabetes mellitus in primary care: a pragmatic cluster randomised controlled trial. BMC Family Practice, 17 (157). pp. 1-18. ISSN 1471-2296


Background: The chronic care model was proven effective in improving clinical outcomes of diabetes in developed countries. However, evidence in developing countries is scarce. The objective of this study was to evaluate the effectiveness of EMPOWER-PAR intervention (based on the chronic care model) in improving clinical outcomes for type 2 diabetes mellitus using readily available resources in the Malaysian public primary care setting. Methods: This was a pragmatic, cluster-randomised, parallel, matched pair, controlled trial using participatory action research approach, conducted in 10 public primary care clinics in Malaysia. Five clinics were randomly selected to provide the EMPOWER-PAR intervention for 1 year and another five clinics continued with usual care. Patients who fulfilled the criteria were recruited over a 2-week period by each clinic. The obligatory intervention components were designed based on four elements of the chronic care model i.e. healthcare organisation, delivery system design, self-management support and decision support. The primary outcome was the change in the proportion of patients achieving HbA1c < 6.5%. Secondary outcomes were the change in proportion of patients achieving targets for blood pressure, lipid profile, body mass index and waist circumference. Intention to treat analysis was performed for all outcome measures. A generalised estimating equation method was used to account for baseline differences and clustering effect. Results: A total of 888 type 2 diabetes mellitus patients were recruited at baseline (intervention: 471 vs. control: 417). At 1-year, 96.6 and 97.8% of patients in the intervention and control groups completed the study, respectively. The baseline demographic and clinical characteristics of both groups were comparable. The change in the proportion of patients achieving HbA1c target was significantly higher in the intervention compared to the control group (intervention: 3.0% vs. control: −4.1%, P < 0.002). Patients who received the EMPOWER-PAR intervention were twice more likely to achieve HbA1c target compared to those in the control group (adjusted OR 2.16, 95% CI 1.34–3.50, P < 0.002). However, there was no significant improvement found in the secondary outcomes. Conclusions: This study demonstrates that the EMPOWER-PAR intervention was effective in improving the primary outcome for type 2 diabetes in the Malaysian public primary care setting.

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Additional Metadata

Item Type: Article
Subject: Type 2 diabetes mellitus; Chronic disease management; Chronic care model; Multifaceted intervention; Clinical outcomes; Primary care; Family medicine
Divisions: Faculty of Medicine and Health Science
DOI Number: https://doi.org/10.1186/s12875-016-0557-1
Publisher: BioMed Central
Depositing User: Nurul Ainie Mokhtar
Date Deposited: 27 Feb 2018 07:25
Last Modified: 27 Feb 2018 07:27
Altmetrics: http://www.altmetric.com/details.php?domain=psasir.upm.edu.my&doi=10.1186/s12875-016-0557-1
URI: http://psasir.upm.edu.my/id/eprint/54073
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