Abstract
Background: Integrated care models have emerged as potential solutions for managing complex health conditions such as diabetes and depression. This prospective study evaluates the effects of an Integrated Care for Patients with Diabetes and Depression (CIC-PDD) model on healthcare utilization and costs.
Methods: Patients with diabetes and depression were randomized into either the Integrated Care (IC) or Usual Care (UC) group. In this pragmatic cluster-randomized trial conducted in community health centers (CHCs) in China, we initially allocated these centers into two groups: the enhanced usual care group (4 CHCs) and the intervention group (4 CHCs). In the intervention group, a comprehensive care plan was developed based on the CIC-PDD model. We recruited individuals aged 18 years or older with diabetes and depression (PHQ-9 ≥ 10). Healthcare utilization, costs, and self-management behaviors were assessed over a 12-month period, using both claim data and questionnaire responses. Statistical analyses were conducted to compare outcomes between the two groups, with missing data being multiply imputed.
Findings: Compared to the UC group, patients in the IC group demonstrated significantly higher outpatient visits (mean difference at 12 months: 1.67 [95% CI, 0.00 to 3.34]) and increased self-treatment instances (mean difference at 12 months: 2.82 [95% CI, 0.60 to 5.03]). Moreover, the IC group also incurred higher self-treatment costs (mean difference at 12 months: RMB437.51 [95% CI, 72.17 to 802.85]) and out-of-pocket expenses (mean difference at 12 months: RMB913.60 [95% CI, 354.36 to 1472.85]). Improvement was observed in self-management behaviors, including Diabetes Self-Care Activities (mean difference at 12 months: 0.69 [95% CI, 0.52 to 0.86]) and medication adherence (mean difference at 12 months: 0.72 [95% CI, 0.37 to 1.07]), among IC group patients.
Interpretation: The CIC-PDD model facilitated the release of healthcare service demand and alleviated unmet needs among patients with diabetes and depression. However, the intervention led to increased short-term costs, highlighting the need for further evaluation of long-term cost-effectiveness. These findings underscore the potential of integrated care approaches in addressing complex health needs in primary healthcare settings.