Analysis of Continuity of Care and Its Related Factors in Diabetic Patients: A Cross-Sectional Study
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Background: Continuity of care in primary care settings is crucial for managing diabetes. We aimed to statistically define and analyze continuity factors associated with demographics, clinical workforce, and geographical relation-ships.Methods: We used 2014–2015 National Health Insurance Service claims data from the Korean registry, with 39,096 eligible outpatient attendance. We applied multivariable logistic regression to analyze factors that may affect the continuity of care indices for each patient: the most frequent provider continuity index (MFPCI), modified-modi-fied continuity index (MMCI), and continuity of care index (COCI).Results: The mean continuity of care indices were 0.90, 0.96, and 0.85 for MFPCI, MMCI and COCI, respectively. Among patient factors, old age >80 years (MFPCI: odds ratio [OR], 0.81; 95% confidence interval [CI], 0.74–0.89; MMCI: OR, 0.84; 95% CI, 0.76–0.92; and COCI: OR, 0.81; 95% CI, 0.74–0.89) and mild disability were strongly associ-ated with lower continuity of care. Another significant factor was the residential area: the farther the patients lived from their primary care clinic, the lower the continuity of diabetes care (MFPCI: OR, 0.74; 95% CI, 0.70–0.78; MMCI: OR, 0.70; 95% CI, 0.66–0.73; and COCI: OR, 0.74; 95% CI, 0.70–0.78).Conclusion: The geographical proximity of patients’ residential areas and clinic locations showed the strongest correlation as a continuity factor. Further efforts are needed to improve continuity of care to address the geographi-cal imbalance in diabetic care.
Abstract
Background: Continuity of care in primary care settings is crucial for managing diabetes. We aimed to statistically define and analyze continuity factors associated with demographics, clinical workforce, and geographical relation-ships.Methods: We used 2014–2015 National Health Insurance Service claims data from the Korean registry, with 39,096 eligible outpatient attendance. We applied multivariable logistic regression to analyze factors that may affect the continuity of care indices for each patient: the most frequent provider continuity index (MFPCI), modified-modi-fied continuity index (MMCI), and continuity of care index (COCI).Results: The mean continuity of care indices were 0.90, 0.96, and 0.85 for MFPCI, MMCI and COCI, respectively. Among patient factors, old age >80 years (MFPCI: odds ratio [OR], 0.81; 95% confidence interval [CI], 0.74–0.89; MMCI: OR, 0.84; 95% CI, 0.76–0.92; and COCI: OR, 0.81; 95% CI, 0.74–0.89) and mild disability were strongly associ-ated with lower continuity of care. Another significant factor was the residential area: the farther the patients lived from their primary care clinic, the lower the continuity of diabetes care (MFPCI: OR, 0.74; 95% CI, 0.70–0.78; MMCI: OR, 0.70; 95% CI, 0.66–0.73; and COCI: OR, 0.74; 95% CI, 0.70–0.78).Conclusion: The geographical proximity of patients’ residential areas and clinic locations showed the strongest correlation as a continuity factor. Further efforts are needed to improve continuity of care to address the geographi-cal imbalance in diabetic care.
참고문헌 (23)
- International Diabetes Federation, "IDF diabetes atlas. 9th ed", International Diabetes Federation, ~ (2019)
- Hussey PS, "Continuity and the costs of care for chronic disease", JAMA Intern Med, 174, pp.742~748 (2014)
- Lustman A, "Interpersonal continuity of care and type two diabetes", Prim Care Diabetes, 10, pp.165~170 (2016)
- Shin DW, "Impact of continuity of care on mortality and health care costs : a nationwide cohort study in Korea", Ann Fam Med, 12, pp.534~541 (2014)
- Health Quality Ontario, "Continuity of care to optimize chronic disease management in the community setting : an evidence-based analysis", Ont Health Technol Assess Ser, 13, pp.1~41 (2013)
- Cheng SH, "A longitudinal examination of continuity of care and avoidable hospitalization : evidence from a universal coverage health care system", Arch Intern Med, 170, pp.1671~1677 (2010)
- Gupta R, "How primary care practices can improve continuity of care", JAMA Intern Med, 173, pp.1885~1886 (2013)
- Koopman RJ, "Continuity of care and recognition of diabetes, hypertension, and hypercholesterolemia", Arch Intern Med, 163, pp.1357~1361 (2003)
- Alazri MH, "UK GPs’ and practice nurses’views of continuity of care for patients with type 2 diabetes", Fam Pract, 24, pp.128~137 (2007)
- 윤채현, "우리나라 당뇨병 환자의 진료 지속성 및 이에 영향을 미치는 요인", 예방의학회지, 40(1), pp.51~58 (2007), 대한예방의학회
- Hong JS, "Relationship between continuity of ambulatory care and medication adherence in adult patients with type 2 diabetes in Korea : a longitudinal analysis", Med Care, 52, pp.446~453 (2014)
- Weiss LJ, "Faithful patients : the effect of long-term physicianpatient relationships on the costs and use of health care by older Americans", Am J Public Health, 86, pp.1742~1747 (1996)
- Given CW, "Evaluation and application of continuity measures in primary care settings", J Community Health, 10, pp.22~41 (1985)
- Magill MK, "A new method for measuring continuity of care in family practice residencies", J Fam Pract, 24, pp.165~168 (1987)
- Bice TW, "A quantitative measure of continuity of care", Med Care, 15, pp.347~349 (1977)
- Laiteerapong N, "The legacy effect in type 2 diabetes : impact of early glycemic control on future complications(The Diabetes & Aging Study)", Diabetes Care, 42, pp.416~426 (2019)
- 은상준, "외래진료 민감질환 유질환자 중장애인과 비장애인의 의료이용률 차이", 예방의학회지, 39(5), pp.411~418 (2006), 대한예방의학회
- "Ministry of Heath and Welfare (MOHW) homepage"[URL]
- Laursen B, "Health service use in adults 20-64 years with traumatic brain injury, spinal cord injury or pelvic fracture : a cohort study with 9-year follow-up", BMJ Open, 2, pp.e001521~ (2012)
- 김미경, "2019 Clinical Practice Guidelines for Type 2 Diabetes Mellitus in Korea", Diabetes and Metabolism Journal, 43(4), pp.398~406 (2019), 대한당뇨병학회[DOI]
- Kauhl B, "Do the risk factors for type 2 diabetes mellitus vary by location? : a spatial analysis of health insurance claims in Northeastern Germany using kernel density estimation and geographically weighted regression", Int J Health Geogr, 15, pp.38~ (2016)
- Bodenheimer T, "The 10building blocks of high-performing primary care", Ann Fam Med, 12, pp.166~171 (2014)
- Starfield B., "Primary care: an increasingly important contributor to effectiveness, equity, and efficiency of health services: SESPAS report 2012", Gac Sanit, 26(Suppl 1), pp.20~26 (2012)