Salleh, Zul Azrizal
(2023)
Process evaluation and cost analysis of the team approach in diabetes management in a primary care setting.
Masters thesis, Universiti Sains Malaysia.
Abstract
Introduction: The Team Approach is a patient-centred multidisciplinary approach in
the management of diabetes that aims to empower patients in the self-care towards
achieving good diabetes control. This study began with the development of the flow
chart and clinical pathway of the Team Approach that guided the process evaluation
and cost analysis of the program and the additional costs that required to improve the
program.
Methodology: This study consisted of three parts. Part 1 of the study is the design and
development of a flow chart and clinical pathway that was developed from observing
the work processes and activities of the Team Approach at the Simpang Kuala health
clinic. The development of the flow chart and clinical pathway was based on the 10-
step framework for developing and disseminating clinical pathway by the Centre of
Evidence-based Practice, University of Pennsylvania Health System, Philadelphia.
Part 2 was a process evaluation of the Team Approach on the program’s context, reach,
dose delivered, fidelity, and implementation. Part 3 of the research was a cost analysis
of the Team Approach using the top-down and bottom-up costing approach to
determine the cost per patient from providers’ perspective. Additional resources and
costs required to expand the program to achieve 50% and 70% of patients with HbA1c
level ≤6.5% was also forecasted.
Result: The Diabetes Patient Process Flow Chart (DPPF) and the Integrated Care
Pathway of Diabetes Management (ICPDM) of the Team Approach work processes
were visualized using the Business Process Model and Notation tool and the time-task
matrix format of a chain model. The process evaluation discovered factors that
influenced the implementation of Team Approach was the leadership of the clinic’s
manager, human resource, facilities and equipment, health informatics, variations in consultation practices, commitments of patients, acceptance of new knowledge, stigma
on insulin use and the effect of Covid-19 pandemic. The scores obtained in the
evaluation of reach, dose delivered and fidelity of the services and consultations in the
Team Approach ranged from 0% to 100%. The overall score for the implementation
of the Team Approach in diabetes management and care was 57%. The cost of
treatment for diabetes patient in 2020 was RM1,330.05 per patient. To achieve 50%
and 70% of the total diabetes patients with HbA1c of ≤6.5% in the same year, the cost
per patient will be RM1,659.34 and RM2,117.68 respectively.
Conclusion: The research is a comprehensive study of the Team Approach in diabetes
management in a primary care setting. The flow chart and clinical pathway will be
useful in standardizing the delivery of care and sharing of practices among other
clinics. Whilst the process evaluation enabled the weaknesses of the program to be
identified, thus aiding future improvements and guiding the Ministry of Health in the
planning resources and funding for the management and care of diabetes mellitus in
Malaysia.
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