Continuity of care and intermediate outcomes of type 2 diabetes mellitus

Background. The relevance of continuity of care in chronic illness is uncertain. Objective. We evaluated whether experienced continuity of care for type 2 diabetes is associated with HbA1c, blood pressure or body weight. Methods. Cohort study in 19 family practices in London, UK. Participants were 209 type 2 diabetic patients with 156 (75%) followed-up at 10 months. Main measures were experienced continuity of care (ECC) by patient questionnaire (mean score 62.1, SD 16.0), satisfaction with care, health-related quality of life [short-form 12 (SF-12)], HbA1c, blood pressure and body weight. Analyses were adjusted for baseline values, age, sex, ethnicity, duration of diabetes, diabetes treatment, education, housing tenure and whether living alone. Results. Experienced continuity scores were obtained for 193 (92%) of participants at baseline and 156 (75%) at follow-up with no difference in outcome measures between those followed-up and those not. Subjects with the highest satisfaction ratings, compared with the lowest, had higher experienced continuity (difference in experienced continuity 7.87, 95% confidence interval 3.22-12.5, P = 0.001). ECC was not associated with HbA1c (adjusted difference per 10-unit increase in ECC score, -0.09%, -0.29 to 0.12%, P= 0.402), systolic blood pressure (-0.41, -2.88 to 2.06 mm Hg, P= 0.746), body mass index (-0.08, -0.34 to 0.18 kg /M2, P= 0.562) or SF-12 physical component score (0.73, -0.88 to 2.35, P= 0.375). Conclusion. Experienced continuity of diabetes care is associated with greater patient satisfaction but not with improved intermediate outcomes during 10 months follow-up in this setting. Studies with more subjects will be required to determine whether continuity of care is associated with the frequency of adverse events.