Effect of the Diabetic Nephropathy Aggravation Prevention Program on Medical Visit Behavior in Individuals Under the Municipal National Health Insurance

Overview

Journal J Diabetes Investig

Specialty Endocrinology

Date 2023 Mar 24

PMID 36960735

Authors

Asuka Ikeda

Makoto Fujii

Yuko Ohno

Kayo Godai

Yaya Li

Yuko Nakamura

Daisuke Yabe

Kazuyo Tsushita

Naoki Kashihara

Kei Kamide

Mai Kabayama

Affiliations

Soon will be listed here.

Abstract

Aims/introduction: We aimed to clarify the effectiveness of the Diabetic Nephropathy Aggravation Prevention Program in Japan by comparing the diabetes-related medical visit behavior of individuals under the municipal national health insurance according to insurers' effort levels.

Materials And Methods: We assessed changes in medical visit behavior according to insurers' effort levels, "Full Efforts," "Some Efforts" and "No Effort," using longitudinal data from the National Database of Health Insurance Claims and Specific Health Checkups before 2015 and after 2018 regarding the national health insurance programs in Japan. We analyzed the effect of the Diabetic Nephropathy Aggravation Prevention Program using a generalized linear mixed model for 208,388 participants with diabetes.

Results: The additive effect on medical visit behavior was significantly higher for insurers with "Full Efforts" than for those with "No Effort;" the coefficient (log odds ratio) was 0.159 (95% confidence interval 0.063-0.256). The additive effects on medical visit behavior sizes for the people with hemoglobin A1c ≥7.0%, positive urinary protein and systolic blood pressure ≥140 mmHg were 0.508, 0.402 and 0.232, respectively, which were larger than the overall effect size (0.159) for insurers with "Full Efforts."

Conclusions: Our findings showed that insurer efforts had an additive effect on the increase in the number of medical visits, suggesting that this national program could reduce the number of end-stage renal failures or dialysis in Japan.

References

Nishioka Y, Takeshita S, Kubo S, Myojin T, Noda T, Okada S . Appropriate definition of diabetes using an administrative database: A cross-sectional cohort validation study. J Diabetes Investig. 2021; 13(2):249-255. PMC: 8847127. DOI: 10.1111/jdi.13641. View

Tsushita K, Muramoto A . [The current situation of newly started lifestyle intervention system to reduce metabolic syndrome in Japan--specific health checkup and health guidance]. Nihon Rinsho. 2011; 69 Suppl 1:723-8. View

Fukuda H, Mizobe M . Impact of nonadherence on complication risks and healthcare costs in patients newly-diagnosed with diabetes. Diabetes Res Clin Pract. 2016; 123:55-62. DOI: 10.1016/j.diabres.2016.11.007. View

Suzuki H, Watanabe T, Uehara T, Kosaki K . Medical genetics and genomic medicine in Japan. Am J Med Genet C Semin Med Genet. 2019; 181(2):166-169. DOI: 10.1002/ajmg.c.31702. View

Bouchi R, Sugiyama T, Goto A, Imai K, Ihana-Sugiyama N, Ohsugi M . Retrospective nationwide study on the trends in first-line antidiabetic medication for patients with type 2 diabetes in Japan. J Diabetes Investig. 2021; 13(2):280-291. PMC: 8847136. DOI: 10.1111/jdi.13636. View

Matsuda S . Health Policy in Japan - Current Situation and Future Challenges. JMA J. 2021; 2(1):1-10. PMC: 7930804. DOI: 10.31662/jmaj.2018-0016. View

Doi Y, Ninomiya T, Hata J, Yonemoto K, Arima H, Kubo M . Proposed criteria for metabolic syndrome in Japanese based on prospective evidence: the Hisayama study. Stroke. 2009; 40(4):1187-94. DOI: 10.1161/STROKEAHA.108.531319. View

Ihana-Sugiyama N, Sugiyama T, Imai K, Yanagisawa-Sugita A, Tanaka H, Ohsugi M . Factors associated with the degree of glycemic deterioration among patients with type 2 diabetes who dropped out of diabetes care: A longitudinal analysis using medical claims and health checkup data in Japan. J Diabetes Investig. 2021; 13(3):571-579. PMC: 8902378. DOI: 10.1111/jdi.13681. View

Masakane I, Nakai S, Ogata S, Kimata N, Hanafusa N, Hamano T . An Overview of Regular Dialysis Treatment in Japan (As of 31 December 2013). Ther Apher Dial. 2016; 19(6):540-74. DOI: 10.1111/1744-9987.12378. View

10.

Hoshino N, Xiuting M, Takahashi Y, Nakayama T . Effect of reminder letters after health checkups on the consultation behavior of participants with possible hypertension, hyperglycemia, and dyslipidemia: A retrospective cohort study using administrative claims data in Japan. J Occup Health. 2021; 63(1):e12231. PMC: 8112116. DOI: 10.1002/1348-9585.12231. View

11.

Sasaki T, Izawa M, Okada Y . Current trends in health insurance systems: OECD countries vs. Japan. Neurol Med Chir (Tokyo). 2015; 55(4):267-75. PMC: 4628174. DOI: 10.2176/nmc.ra.2014-0317. View

12.

Ballarini N, Chiu Y, Konig F, Posch M, Jaki T . A critical review of graphics for subgroup analyses in clinical trials. Pharm Stat. 2020; 19(5):541-560. PMC: 8647927. DOI: 10.1002/pst.2012. View

13.

Abdul Rashid R, Mohamed M, Hamid Z, Dahlui M . Is the phone call the most effective method for recall in cervical cancer screening?--results from a randomised control trial. Asian Pac J Cancer Prev. 2013; 14(10):5901-4. DOI: 10.7314/apjcp.2013.14.10.5901. View

14.

. [Definition and the diagnostic standard for metabolic syndrome--Committee to Evaluate Diagnostic Standards for Metabolic Syndrome]. Nihon Naika Gakkai Zasshi. 2005; 94(4):794-809. View

15.

Tsuda K, Tsutsumi A, Kawakami N . Work-related factors associated with visiting a doctor for a medical diagnosis after a worksite screening for diabetes mellitus in Japanese male employees. J Occup Health. 2004; 46(5):374-81. DOI: 10.1539/joh.46.374. View

16.

Smith D, Norton J, Weinberger M, McDonald C, Katz B . Increasing prescribed office visits. A controlled trial in patients with diabetes mellitus. Med Care. 1986; 24(3):189-99. View

17.

Vogt T, Glass A, Glasgow R, La Chance P, Lichtenstein E . The safety net: a cost-effective approach to improving breast and cervical cancer screening. J Womens Health (Larchmt). 2003; 12(8):789-98. DOI: 10.1089/154099903322447756. View

18.

Chrvala C, Sherr D, Lipman R . Diabetes self-management education for adults with type 2 diabetes mellitus: A systematic review of the effect on glycemic control. Patient Educ Couns. 2015; 99(6):926-43. DOI: 10.1016/j.pec.2015.11.003. View