| Objectives By comparing the diabetics within and outside the chronic disease scheme (CDS), evaluate the effect of CDS and individual condition of the patient on chronic disease treatment. Through the follow-up investigation, identify barriers to joining the CDS, and analyze the changes in the knowledge about CDS and the quality of life of diabetics. By evaluating the functioning of CDS, provide theoretical and practical suggestion for the government to improve the CDS, and to protect the health of diabetes in rural areas.Methods This was a longitudinal study of two matched cohorts, one with the intervention (the CDS) and one without. Those within the CDS at baseline are referred to as’cases’and those not as’referents’:the referents, matched to the cases on age, sex and village, give an indication of how the cases would have fared without the intervention, the CDS. Descriptive statistics, chi-square test, logistic regression analysis and paired t-test were used for statistical analysis.Results (1) Cases and referents were no significant difference in a hierarchical age, education level, working status, household income, smoking, alcohol consumption and body mass index; but cases reported a longer time since diagnosis, and more drug and insulin use than referents.(2) By the time of the follow-up,27.5%of referents reported that they had applied for the CDS, but among those who had not, lack of knowledge was given as the main reason, either about the CDS itself or about the mechanism for applying.(3) Different requirements of chronic disease Card application and compensation in different regions, the knowledge about CDS, patient’s disease severity and economic pressure are the main factors influencing for chronic disease Card application.(4)67.5%of cases got compensation from CDS in the last year, among the remaining cases who had not. the restrictions of CDS on the types of drugs and place of purchase of medicines was given as the main barriers.(5) The village clinic doctor was an important source of information about CDS. Cases know much more knowledge about the CDS than referents. By comparing with baseline, the knowledge about CDS was significantly improved in cases and referents joining the CDS in follow-up; there was no significantly change in referents outside the CDS. But the numbers of correct answers for CDS were not good enough overall.(6) Cases were more likely to visit medical institutions above village-level, and the frequency was much more than referents. Compared with baseline, the numbers of visiting the medical institutions above village-level were increased in cases, referents joining the CDS. but decreased in referents outside the CDS.(7) Cases reported the costs more burdensome than referents. Those in the scheme, or joining since baseline, were more likely to report the costs less burdensome at follow-up.(8) There was no significant difference in Glycosylated hemoglobin (HbAlc) between cases and referents. Compared with baseline data, HbAlc of referents outside the CDS increased more sharply than the cases increased; but declined in referents joining the CDS.(9) EQ-VAS score, PCS and MCS of referents were higher than cases’. Compared with baseline data, EQ-VAS score in each group was significantly increased; The PCS score increased more obvious in cases than in other groups; MCS improved significantly only in cases, but no significant changes in other two groups.Conclusion Joining the CDS plays a positive role in enhancing knowledge about CDS, promoting diabetes to use more resources of medical institutions above the village-level, enhancing the quality of life of diabetics in rural areas, and the effect is more obvious in the psychological dimension. Besides, the control of HbAlc is better in group joining the CDS than in group not joining. Therefore, the implementation of CDS could reduce the economic burden of diabetics in rural areas, and increase their health status and quality of life in a certain extent. |
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