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

Abstract

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; diabetes mellitus; end-stage renal disease; hospitalization.

Figure 1

Flowchart of patient selection. Abbreviation: ESRD, end-stage renal disease.

Figure 2

Level of continuity of care by patient characteristics before and after propensity weighting. Abbreviations: COC, continuity of care; IPTW, inverse probability of treatment weighting; MPR, medication possession ratio.

Figure 3

Kaplan–Meier curves showing ESRD survival and hospitalization survival among COC groups. Abbreviations: COC, continuity of care; ESRD, end-stage renal disease.

Figure 4

Multivariable stratified analyses for the association between continuity of care and ESRD and hospitalization after propensity weighting. Note: ^aAdjusted for age, gender, hypertension, dyslipidemia, gout, chronic kidney disease, Charlson comorbidity score, number of antihyperlycemic drugs, number of visits, and adherrence level. Abbreviations: COCI, continuity of care index; ESRD, end-stage renal disease; HR, hazard ratio; MPR, medication possession ratio.