Continuity of care with physicians and risk of subsequent hospitalization and end-stage renal disease in newly diagnosed type 2 diabetes mellitus patients

Abstract

Po-Ya Chang,1 Li-Nien Chien,2 Chyi-Huey Bai,1 Yuh-Feng Lin,3 Hung-Yi Chiou1 1School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan; 2School of Health Care Administration, Taipei Medical University, Taipei, Taiwan; 3Graduate Institute of Clinical Medicine, Taipei Medical University, Taipei, Taiwan Purpose: Effective management for type 2 diabetes mellitus (DM) can slow the progression of kidney outcomes and reduce hospital admissions. Better continuity of care (COC) was found to improve patients’ adherence and self-management. This study examined the associations between COC, hospitalization, and end-stage renal disease (ESRD) in DM patients.Patients and methods: In the cohort study, data from 1996 to 2012 were retrieved from the Longitudinal Health Insurance Database, using inverse probability weighted analysis. A total of 26,063 patients with newly diagnosed type 2 DM who had been treated with antihyperglycemic agents were included. COC is to assess the extent to which a DM patient visited the same physician during the study period. This study categorized COC into 3 groups – low, intermediate, and high, – according to the distribution of scores in our sample.Results: The number of ESRD patients in the high, intermediate, and low COC groups were 92 (22.33%), 130 (31.55%), and 190 (46.12%), respectively, and the mean follow-up periods for the 3 groups were 7.13, 7.12, and 7.27 years, respectively. After using inverse probability weighting, the intermediate and low COC groups were significantly associated with an increased risk of ESRD compared with the high COC group (adjusted hazard ratio (aHR) 1.36 [95% CI, 1.03–1.80] and aHR 1.76 [95% CI, 1.35–2.30], respectively). The intermediate and low COC groups were also significantly associated with the subsequent hospitalization compared with the high COC group (aHR 1.15 [95% CI, 0.99–1.33] and aHR 1.72 [95% CI, 1.50–1.97], respectively).Conclusion: COC is related to ESRD onset and subsequent hospitalization among patients with DM. This study suggested that when DM patients keep visiting the same physician for managing their diseases, the progression of renal disease can be prevented. Keywords: continuity of care, end-stage renal disease, hospitalization, diabetes mellitus

Keywords

• continuity of care
• end-stage renal disease
• hospitalization
• diabetes mellitus