Diabetes mellitus (DM) is one of the top ten causes of disability in the world and undermines productivity and human development [1]. In China, it is estimated that the prevalence of diabetes is 9.4% in 2016 and approximately 224,700 people die from diabetes [2]. It is therefore particularly important that the public health system ensures the delivery of effective healthcare services to those with the disease.
China’s National Plan for Non-Communicable Diseases (NCDs) Prevention and Treatment (2012–2015) adopts primary healthcare approach highlighting the importance of early diagnosis and early treatment of NCDs [3]. Type 2 DM has been identified as one of the priority diseases in China. According to the national guideline for implementation of the basic public health service package, case management should be provided with patients with Type 2 DM once a quarter aiming to monitor the disease progression, guide the treatment and promote healthy lifestyle [4]. The recommended services for case management included blood glucose test and other relevant examinations, routine physical check-up, health education and nutrition guidance.
In China, there are three basic health insurance schemes covering over 95% of the population. They are Urban Employee Basic Medical Insurance (UEBMI), Urban Residence Basic Medical Insurance (URBMI) and New Rural Cooperative Medical Scheme (NCMS) [5, 6]. UEBMI has relatively comprehensive coverage of health services. URBMI and NCMS largely cover inpatient care, and in the recent years they also provide outpatient coverage, albeit the benefit package being modest [7].
Chongqing is one of the largest cities located in the western China, with a total population of over 30 million. The prevalence of diabetes in Chongqing was 10.7% in 2014 [8]. In 2010, the two schemes, URBMI and NCMS were integrated in one scheme, named as Urban–rural Residence Basic Medical Insurance (URRBMI) in Chongqing. This scheme and UEBMI have a targeted disease reimbursement program to provide a higher level of reimbursement for outpatient care for 20 priority disease, including DM [5]. In line with the national plan for NCDs management and treatment, the provincial government has issued a practice guideline targeting on management of elder people and patients with Type 2 DM and hypertension, which has introduced a set of indicators for monitoring and evaluation of NCDs management [9]. Regarding the diabetic case management, the guideline recommended one face-to-face visit every quarter and a comprehensive check-up and in a year (including routine blood and urine tests, electrocardiogram, liver and kidney function examinations, HbA1c test and diabetic eyes screening).
Many previous studies in China focused on the treatment of Type 2 DM [10, 11] but few studies examined case management for Type 2 DM patients. This study investigated the frequency of follow-up visits and contents of care for case management of patients with Type 2 DM in Chongqing, in terms of regional practice guideline; and analyzed factors associated with the use of care.