당뇨병 환자의 복약순응도에 상용치료원이 미치는 영향과 우울의 조절효과 = The Effect of Usual Source of Care on Medication Adherence of Patients with Diabetes and the Moderating Effect of Depression

다국어 초록 (Multilingual Abstract)

Background: Continuity of care is crucial in diabetes treatment, which requires ongoing management. However, the comorbidity of depression and diabetes can disrupt this continuity. This study aimed to examine the role of usual source of care (USC) in diabetes treatment and how its effect changes in the presence of depression. We analyzed the effect of USC on medication adherence, a key component of diabetes management, and investigated how this effect varies when diabetes is accompanied by depression. Methods: The 2020 Korea Health Panel Data were used to examine 1,484 adults aged 19 or older with diabetes. The effect of USC on medication adherence was verified using multivariate logistic regression analysis with USC as the independent variable and medication adherence as the dependent variable. Additionally, the moderating effect of depression on the effect of USC on medication adherence was tested using the PROCESS moderation model and two-way analysis of variance. Results: Among the 1,484 diabetes patients, the proportion experiencing depressive symptoms was 11.7%. Of the study participants, 76.8% had a USC, and 65.6% demonstrated medication adherence. The adherence rate was lower in the depressive group compared to the nondepressive group (t=2.34, p<0.05). The odds of medication adherence were 1.60 times higher in the group with USC compared to the group without (odds ratio [OR], 1.60; 95% confidence interval [CI], 1.24–2.06; p<0.001). When analyzed separately for the depressive and non-depressive groups, the non-depressive group showed higher medication adherence when having USC (OR, 1.72; 95% CI, 1.31–2.25; p<0.001), whereas this was not the case for the depressive group. The interaction effect of having USC and depressive symptoms on medication adherence was tested, confirming the moderating effect of depression (B=–0.71, p<0.05). When there are no depressive symptoms, having USC is associated with higher medication adherence, but this effect diminishes in the presence of depressive symptoms. Conclusion: This study confirmed the importance of USC in enhancing medication adherence and that the negative mental health condition of depression can diminish this effect. There is a need for institutional support to expand the positive functions of USC in managing diabetes, a chronic disease. For patients with depressive symptoms, supplementary intervention strategies may be necessary for their mental health in addition to USC

참고문헌 (Reference)

• 1 Skinner TC, "Twenty-five years of diabetes distress research" 37 (37): 393-400, 2020
• 2 Seo, B.J., "The relationship between outpatient medication adherence and diabetic complications in patients with type 2 diabetes: focusing on the National Health Insurance Corporation standard cohort database from 2002 to 2013" Yonsei University 2013
• 3 Anderson RJ, "The prevalence of comorbid depression in adults with diabetes : a metaanalysis" 24 (24): 1069-1078, 2001
• 4 Baron RM, "The moderator-mediator variable distinction in social psychological research : conceptual, strategic, and statistical considerations" 51 (51): 1173-1182, 1986
• 5 임유나 ; 이태진, "The effect of usual source of care(USOC)on health care utilization in Korea" 44 (44): 3-24, 2024
• 6 김두리, "The effect of having usual source of care on the choice among different types of medical facilities" 26 (26): 195-206, 2016
• 7 Katon WJ, "The association of comorbid depression with mortality in patients with type 2 diabetes" 28 (28): 2668-2672, 2005
• 8 신세라, "The association between types of usual source of care and medication adherence among the elderly" 21 (21): 609-621, 2021
• 9 정연 ; 변진옥, "The association between having a usual source of care and adherence to medicines in patients with chronic diseases" 26 (26): 128-136, 2016
• 10 Roy JF, "The TELE-DD project on treatment nonadherence in the population with type 2 diabetes and comorbid depression" 11 : 8889-, 2021
• 11 Mainous AG 3rd, "Relationship between continuity of care and diabetes control : evidence from the Third National Health and Nutrition Examination Survey" 94 : 66-70, 2004
• 12 Snoek FJ, "Mental health in diabetes care : time to step up" 3 : 1039192-, 2022
• 13 Starfield B, "Is primary care essential?" 344 (344): 1129-1133, 1994
• 14 O’Connor PJ, "Is having a regular provider of diabetes care related to intensity of care and glycemic control?" 47 : 290-297, 1998
• 15 Hayes AF, "Introduction to mediation, moderation, and conditional process analysis: a regression-based approach" The Guilford Press 2022
• 16 Derese A, "Impact of depression on self-efficacy, illness perceptions and self-management among people with type 2 diabetes : a systematic review of longitudinal studies" 19 (19): e0302635-, 2024
• 17 송은주 ; 김영은 ; 지선미, "Impact of a primary health care chronic diseases management pilot program" 96 (96): 7-12, 2021
• 18 이소담 ; 신의철 ; 임재영 ; 이상규 ; 김지만, "Effects of usual source of care by patients with diabetes on use of medical service and medical expenses" 22 (22): 1-17, 2017
• 19 신양준 ; 우경숙 ; 신영전, "Effects of outpatient continuity of primary care on hospitalization in patients with diabetes mellitus : focused on new patients in 2012" 29 (29): 262-276, 2019
• 20 Chan KS, "Effects of continuity of care on health outcomes among patients with diabetes mellitus and/or hypertension : a systematic review" 22 (22): 145-, 2021
• 21 윤성훈 ; 송연재 ; 권순만, "Effect of usual source of care on health behavior of the middle aged and the elderly" 32 (32): 29-44, 2022
• 22 Li C, "Effect of usual source of care on depression among Medicare beneficiaries : an application of a simultaneous-equations model" 46 (46): 1059-1081, 2011
• 23 Kim YY, "Effect of medication adherence on long-term all-cause-mortality and hospitalization for cardiovascular disease in 65, 067 newly diagnosed type 2 diabetes patients" 8 (8): 12190-, 2018
• 24 Egede LE, "Effect of comorbid depression on quality of life in adults with type 2 diabetes" 13 (13): 83-91, 2013
• 25 Diabetes Canada Clinical Practice Guidelines Expert Committee, "Diabetes and mental health" 42 (42): S130-, 2018
• 26 Egede LE, "Diabetes and depression : global perspectives" 87 (87): 302-312, 2010
• 27 Noh JH, "Depressive symptoms of type 2 diabetics treated with insulin compared to diabetics taking oral anti-diabetic drugs : a Korean study" 69 (69): 243-248, 2005
• 28 Gonzalez JS, "Depression, self-care, and medication adherence in type 2 diabetes : relationships across the full range of symptom severity" 30 (30): 2222-2227, 2007
• 29 김수연 ; 이재호 ; 김하늘 ; 김동규 ; 나영 ; 김길선 ; 김미경 ; 백기현 ; 강무일 ; 이광우 ; 송기호, "Depression and self-care behavior in patients with diabetes mellitus" 33 (33): 432-438, 2009
• 30 Gonzalez JS, "Depression and diabetes treatment nonadherence : a metaanalysis" 31 (31): 2398-2403, 2008
• 31 Sartorius N, "Depression and diabetes" 20 (20): 47-52, 2018
• 32 Sung NJ, "Current status, trends, and related factors of usual source of care for adults in Korea" National Health Insurance Service 2021
• 33 Bae BR, "Analyses of moderating and mediating effects with SPSS/PROCESS" Cheonglam 2021
• 34 Piette JD, "Addressing the needs of patients with multiple chronic illnesses : the case of diabetes and depression" 10 (10): 152-162, 2004
• 35 American Diabetes Association, "4. Foundations of care: education, nutrition, physical activity, smoking cessation, psychosocial care, and immunization" 38 (38): S20-S30, 2015
• 36 Korea Institute for Health and Social Affairs, "2021 Korea Health Panel Survey basic analysis report (II)" Korea Institute for Health and Social Affairs 2023