Health Policy and Management (보건행정학회지)

Korean Academy of Health Policy and Management (한국보건행정학회)
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Effects of Outpatient Continuity of Primary Care on Hospitalization in Patients with Diabetes Mellitus: Focused on New Patients in 2012

당뇨병 환자의 일차의료 외래 지속성이 입원에 미치는 영향: 2012년도 신규 당뇨병 환자를 중심으로

  • 신양준 (한양대학교 건강과 사회연구소) ;
  • 우경숙 (한양대학교 건강과 사회연구소) ;
  • 신영전 (한양대학교 건강과 사회연구소)
  • Received : 2019.02.01
  • Accepted : 2019.06.28
  • Published : 2019.09.30
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Abstract

Background: The most important thing to strengthen primary care is to prove that the continuity of primary care is an essential area for good health outcomes. The purpose of this study is to analyze the effect of outpatient continuity of primary care on the hospitalization experience of diabetes mellitus in new diabetic patients. Methods: Using the Korean National Health Insurance Service national sample cohort (NHIS-NSC 2011-2015) data, 3,391 new diabetic patients in 2012 were selected for the study. Multiple logistic regression was performed to investigate the effect of outpatient continuity of primary care on hospitalization in new diabetic patients. Results: The outpatient continuity of primary care in new diabetic patients was measured by the continuity of care index, which showed that 69.4% (n=2,352) were high level and 30.6% (n=1,039) were low level. Patients who had high continuity of primary care at the early stage of diabetes diagnosis showed 3.49 times more likely to maintain high continuity of primary care in the second year (95% confidence interval [CI], 2.72-4.49). Patients with low continuity of primary care for 2 years from the initial diagnosis of diabetes were 2.56 times more likely to be hospitalized due to diabetes than those who did not (95% CI, 1.55-4.25). Conclusion: This study identified the need for policies to increase the continuity of primary care for new diabetic patients and could contribute to lowering the admission rate of diabetic patients if the policy for this would work effectively.

Keywords

References

  1. Starfield B. Is primary care essential? Lancet 1994;344(8930): 1129-1133. DOI: https://doi.org/10.1016/s0140-6736(94)90634-3.
  2. Walters DJ, Toombs M, Rabuka LA. Strengthening the foundation: the physician’s vital role in primary health care in Canada. CMAJ 1994;150(6):839-847.
  3. Donaldson MS, Yordy KD, Lohr KN, Vanselow NA. Primary care: America's health in a new era. Washington (DC): National Academies Press; 1996.
  4. Lee JH, Choi YJ, Volk RJ, Kim SY, Kim YS, Park HK, et al. Defining the concept of primary care in South Korea using a Delphi method: secondary publication. Health Policy Manag 2014;24(1):100-106. DOI: https://doi.org/10.4332/KJHPA.2014.24.1.100.
  5. Freeman G, Hughes J. Continuity of care and the patient experience. London: The King's Fund; 2010.
  6. Given CW, Branson M, Zemach R. Evaluation and application of continuity measures in primary care settings. J Community Health 1985;10(1):22-41. DOI: https://doi.org/10.1007/bf01321357.
  7. Kim YY, Choi BY, Park HB. The continuity indices of medical insurance patients visiting primary care units in Seoul, Korea. Hanyang J Med 1988;8(2):697-708.
  8. Jung HJ, Lee GY, Park TJ, Kim BS, Han EJ, Bak JJ, et al. The factors influencing the continuity of patient care in family practice. J Korean Acad Fam Med 1997;18(7):731-738.
  9. Saultz JW, Lochner J. Interpersonal continuity of care and care outcomes: a critical review. Ann Fam Med 2005;3(2):159-166. DOI: https://doi.org/10.1370/afm.285.
  10. Wolinsky FD, Bentler SE, Liu L, Geweke JF, Cook EA, Obrizan M, et al. Continuity of care with a primary care physician and mortality in older adults. J Gerontol A Biol Sci Med Sci 2010;65(4):421-428. DOI: https://doi.org/10.1093/gerona/glp188.
  11. Tammes P, Salisbury C. Continuity of primary care matters and should be protected. BMJ 2017;356:j373. DOI: https://doi.org/10.1136/bmj.j373.
  12. Nutting PA, Goodwin MA, Flocke SA, Zyzanski SJ, Stange KC. Continuity of primary care: to whom does it matter and when? Ann Fam Med 2003;1(3):149-155. DOI: https://doi.org/10.1370/afm.63.
  13. Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q 2005;83(3):457-502. DOI: https://doi.org/10.1111/j.1468-0009.2005.00409.x.
  14. McWhinney IR. Continuity of care in family practice: part 2: implications of continuity. J Fam Pract 1975;2(5):373-374.
  15. Haggerty JL, Reid RJ, Freeman GK, Starfield BH, Adair CE, McKendry R. Continuity of care: a multidisciplinary review. BMJ 2003;327(7425):1219-1221. DOI: https://doi.org/10.1136/bmj.327.7425.1219.
  16. Reid R, Haggerty J, McKendry R. Defusing the confusion: concepts and measures of continuity of healthcare. Ottawa (ON): Canadian Health Services Research Foundation; 2002.
  17. Jung SH, Woo KS, Choi CS, Hong JS, Son CW. Chronic disease management plan of clinic. Wonju: Health Insurance Review and Assessment Service; 2009.
  18. Korean Diabetes Association. Diabetes fact sheet in Korea 2018. Seoul: Korean Diabetes Association; 2018.
  19. Irwin KA, Agius M. How does continuity of care affect quality of care in primary healthcare? Psychiatr Danub 2017;29(Suppl 3): 452-456.
  20. Min DK, Choi SA, Choi YH, Lee JH. Possession of a medical doctor as a usual source of care in patients with diabetes and its associated socioeconomic factors in South Korea. Korean J Fam Pract 2015;5(3):289-295.
  21. Oh YH. Improvement ways for health care delivery system. Health Welf Policy Forum 2012;(189):50-67.
  22. Yoon KJ, Oh YH, Lee SH, Ha SY, Yeo JY, Kim JH, et al. Issues and improving strategies on Korea healthcare delivery system. Sejong: Korea Institute for Health and Social Affairs; 2014.
  23. Kang HJ. Policy direction for decreasing the concentration of patients to extra-large hospitals. Health Welf Policy Forum 2014;(210):65-76.
  24. Ko BS. Strengthen primary care and establish delivery system. Healthc Policy Forum 2017;15(4):32-36.
  25. Choi YJ, Ko BS, Cho KH, Lee JH. Concept, values, current status and prospect of primary care in Korea. J Korean Med Assoc 2013;56(10):856-865. DOI: https://doi.org/10.5124/jkma.2013.56.10.856.
  26. Ministry of Health and Welfare. Primary care chronic disease management pilot project introduction. Sejong: Ministry of Health and Welfare, Korea Health Promotion Institute; 2018.
  27. Kim NH. Introduction of chronic disease management program for community-based primary care reinforcement and future development plan. HIRA Policy Trends 2018;12(5):18-27.
  28. Choi YJ. A study on the continuity of primary care among the child and adolescent patients in Korea [dissertation]. Seoul: Seoul National University; 2006.
  29. Kim J, Kim H, Kim H, Min KW, Park SW, Park IB, et al. Current status of the continuity of ambulatory diabetes care and its impact on health outcomes and medical cost in Korea using national health insurance database. J Korean Diabetes Assoc 2006;30(5):377-387. DOI: https://doi.org/10.4093/jkda.2006.30.5.377.
  30. Choi YJ, Kang SH, Kim YI. Association of higher continuity of primary care with lower risk of hospitalization among children and adolescent patients. Health Policy Manag 2009;18(1):85-107. DOI: https://doi.org/10.4332/kjhpa.2008.18.1.085.
  31. Yoon CH, Lee SJ, Choo S, Moon OR, Park JH. Continuity of care of patient with diabetes and its affecting factors in Korea. J Prev Med Public Health 2007;40(1):51-58. DOI: https://doi.org/10.3961/jpmph.2007.40.1.51.
  32. Hong JS, Kim JY, Kang HC. Continuity of ambulatory care among adult patients with type 2 diabetes and its associated factors in Korea. Health Policy Manag 2009;19(2):51-70. DOI: https://doi.org/10.4332/KJHPA.2009.19.2.051.
  33. Hong JS, Kang HC, Kim J. Continuity of care for elderly patients with diabetes mellitus, hypertension, asthma, and chronic obstructive pulmonary disease in Korea. J Korean Med Sci 2010;25(9):1259-1271. DOI: https://doi.org/10.3346/jkms.2010.25.9.1259.
  34. Ahn LS. Effects of continuity of primary care on the hospitalization and the emergency department use for patients with hypertension and diabetes mellitus [dissertation]. Seoul: Korea University; 2009.
  35. Ahn LS. Effects of the continuity of care on hospital utilization: convergence a propensity score matching analysis. J Digit Converg 2015;13(9):323-332. DOI: https://doi.org/10.14400/JDC.2015.13.9.323.
  36. Shin DW, Cho J, Yang HK, Park JH, Lee H, Kim H, et al. Impact of continuity of care on mortality and health care costs: a nationwide cohort study in Korea. Ann Fam Med 2014;12(6):534-541. DOI: https://doi.org/10.1370/afm.1685.
  37. Cho KH, Nam CM, Choi Y, Choi JW, Lee SH, Park EC. Impact of continuity of care on preventable hospitalization of patients with type 2 diabetes: a nationwide Korean cohort study, 2002-10. Int J Qual Health Care 2016;28(4):478-485. DOI: https://doi.org/10.1093/intqhc/mzw050.
  38. Nam YS, Cho KH, Kang HC, Lee KS, Park EC. Greater continuity of care reduces hospital admissions in patients with hypertension: an analysis of nationwide health insurance data in Korea, 2011-2013. Health Policy 2016;120(6):604-611. DOI: https://doi.org/10.1016/j.healthpol.2016.04.012.
  39. Kim YY, Park SM. Following the early-stage MPR (medication possession ratio) on diabetic patients, increases the mortality rate by up to 45%. Cheongnyeon-uisa [Internet]. 2018 Sep 14 [cited 2019 Jan 16]. Available from: http://www.docdocdoc.co.kr/news/articleView.html?idxno=1060410.
  40. Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-Year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 2008;359(15):1577-1589. DOI: https://doi.org/10.1056/NEJMoa0806470.
  41. Lee KU. Treatment guideline for diabetes. Seoul: Korean Diabetes Association; 2015.
  42. Kim KH. Comorbidity adjustment in health insurance claim database. Health Policy Manag 2016;26(1):71-78. DOI: https://doi.org/10.4332/KJHPA.2016.26.1.71.
  43. Korean Diabetes Association. Report of task force team for basic statistical study of Korean diabetes mellitus: diabetes in Korea 2007. Seoul: Korean Diabetes Association; 2008.
  44. Hong JS, Kim JY. Index of continuity in the utilization of primary care services. HIRA Policy Trends 2008;2(6):38-48.
  45. Bice TW, Boxerman SB. A quantitative measure of continuity of care. Med Care 1977;15(4):347-349. DOI: https://doi.org/10.1097/00005650-197704000-00010.
  46. Shortell SM. Continuity of medical care: conceptualization and measurement. Med Care 1976;14(5):377-391. DOI: https://doi.org/10.1097/00005650-197605000-00001.
  47. Christakis DA, Wright JA, Koepsell TD, Emerson S, Connell FA. Is greater continuity of care associated with less emergency department utilization? Pediatrics 1999;103(4 Pt 1):738-742. DOI: https://doi.org/10.1542/peds.103.4.738.
  48. Knight J, Worrall G, Gadag V, Murphy D, Sikdar K. Continuity of care in elderly diabetics within a universally-insured health care system. Am J Epidemiol 2006;163(11):S182. DOI: https://doi.org/10.1093/aje/163.suppl_11.S182-c.
  49. Worrall G, Knight J. Continuity of care is good for elderly people with diabetes: retrospective cohort study of mortality and hospitalization. Can Fam Physician 2011;57(1):e16-e20.
  50. Cho KH, Lee SG, Jun B, Jung BY, Kim JH, Park EC. Effects of continuity of care on hospital admission in patients with type 2 diabetes: analysis of nationwide insurance data. BMC Health Serv Res 2015;15:107. DOI: https://doi.org/10.1186/s12913-015-0745-z.
  51. Jang YJ, Choy YS, Nam CM, Moon KT, Park EC. The effect of continuity of care on the incidence of end-stage renal disease in patients with newly detected type 2 diabetic nephropathy: a retrospective cohort study. BMC Nephrol 2018;19(1):127. DOI: https://doi.org/10.1186/s12882-018-0932-3.
  52. Hsu CH, Chou YJ, Pu C. The effect of continuity of care on emergency room use for diabetic patients varies by disease severity. J Epidemiol 2016;26(8):413-419. DOI: https://doi.org/10.2188/jea.JE20150045.
  53. Casparie AF, van der Waal MA. Differences in preferences between diabetic patients and diabetologists regarding quality of care: a matter of continuity and efficiency of care? Diabet Med 1995;12(9): 828-832. DOI: 10.1111/j.1464-5491.1995.tb02087.x.
  54. Wasson JH, Sauvigne AE, Mogielnicki RP, Frey WG, Sox CH, Gaudette C, et al. Continuity of outpatient medical care in elderly men: a randomized trial. JAMA 1984;252(17):2413-2417. DOI: https://doi.org/10.1001/jama.1984.03350170015011.
  55. Barker I, Steventon A, Deeny SR. Association between continuity of care in general practice and hospital admissions for ambulatory care sensitive conditions: cross sectional study of routinely collected, person level data. BMJ 2017;356:j84. DOI: https://doi.org/10.1136/bmj.j84.
  56. Kim Y. Complete conquest of diagnosis related group. Peoplepower21 2012;(165):10-13.
  57. Gulliford MC, Naithani S, Morgan M. Continuity of care and intermediate outcomes of type 2 diabetes mellitus. Fam Pract 2007; 24(3):245-251. DOI: https://doi.org/10.1093/fampra/cmm014.
  58. Hjortdahl P, Laerum E. Continuity of care in general practice: effect on patient satisfaction. BMJ 1992;304(6837):1287-1290. DOI: https://doi.org/10.1136/bmj.304.6837.1287.
  59. Koopman RJ, Mainous AG 3rd, Baker R, Gill JM, Gilbert GE. Continuity of care and recognition of diabetes, hypertension, and hypercholesterolemia. Arch Intern Med 2003;163(11):1357-1361. DOI: https://doi.org/10.1001/archinte.163.11.1357.
  60. Choi YG, Kim K, Choi YJ, Sung NJ, Kim J, Park JH, et al. Patient assessment of primary care of health cooperative clinics in South Korea. Korean J Fam Med 2010;31(10):765-777. DOI: https://doi.org/10.4082/kjfm.2010.31.10.765.
  61. Lee JH, Ko BS, Leem JH, Lee SI. Standard model and quality appraisal framework for the organization of primary care. J Korean Med Assoc 2013;56(10):866-880. DOI: https://doi.org/10.5124/jkma.2013.56.10.866.
  62. Jeong H, Lee H, Lee JH, Lee T. Payment reform for the improvement of primary care in Korea. J Korean Med Assoc 2013;56(10):881-890. DOI: https://doi.org/10.5124/jkma.2013.56.10.881.
  63. Yoon HS, Lee SI. Primary care and health care reform in Korea. Sejong: Korea Development Institute; 2012.