Effects of the integrated care on healthcare utilization and costs among patients with diabetes and depression: a cluster-randomized controlled trial.
Yanshang Wang, Dan Guo, Mingzheng Hu et al.
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In 30 seconds
This cluster-randomized controlled trial in community health centers in China assessed whether Community-based Integrated Care for Patients with Diabetes and Depression affected healthcare use and costs. Participants were adults with type 2 diabetes and depression (PHQ-9 ≥ 10); 275 received integrated care and 355 enhanced usual care. At 12 months, integrated care was associated with more outpatient visits (mean difference: 1.35; 95% CI, 0.45-2.24; P = .003) and higher self-treatment use, self-treatment costs, and out-of-pocket expenses. The authors suggest these increases may indicate greater healthcare engagement and self-management.
Key findings
- At 12 months, integrated care participants had 1.35 more outpatient visits than controls (95% CI, 0.45-2.24; P = .003).
- Self-treatment use was higher with integrated care (2.57; 95% CI, 0.02-5.13; P = .049).
- Self-treatment costs were higher ($67.16; 95% CI, 9.45-124.87; P = .023), as were out-of-pocket expenses ($127.21; 95% CI, 41.79-212.63; P = .004).
Why it matters
People managing both diabetes and depression may have unmet healthcare needs. This trial indicates that integrated care can be accompanied by increased outpatient contact and self-treatment, alongside higher costs paid by patients. These outcomes help frame evaluation of integrated models: greater utilization and spending may reflect improved engagement, but also represent additional financial burden.
What to keep in mind
The abstract reports outcomes at 6 and 12 months but provides significant comparative results only at 12 months; longer-term effects are not established.