Objectives The goal of this study was to identify association between the continuity of ambulatory care of diabetes patients in South Korea (hereafter Korea) and the incidence of macrovascular complications of diabetes, using claims data compiled by the National Health Insurance Services of Korea.
Methods This study was conducted retrospectively. The subjects of the study were 43 002 patients diagnosed with diabetes in 2007, who were over 30 years of age, and had insurance claim data from 2008. The macrovascular complications of diabetes mellitus were limited to ischemic heart disease and ischemic stroke. We compared the characteristics of the patients in whom macrovascular complications occurred from 2009 to 2012 to the characteristics of the patients who had no such complications. Multiple logistic regression was used to assess the effects of continuity of ambulatory care on diabetic macrovascular complications. The continuity of ambulatory diabetes care was estimated by metrics such as the medication possession ratio, the quarterly continuity of care and the number of clinics that were visited.
Results Patients with macrovascular complications showed statistically significant differences regarding sex, age, comorbidities, hypertension, dyslipidemia and continuity of ambulatory diabetes care. Visiting a lower number of clinics reduced the odds ratio for macrovascular complications of diabetes. A medication possession ratio below 80% was associated with an increased odds ratio for macrovascular complications, but this result was of borderline statistical significance.
Conclusions Diabetes care by regular health care providers was found to be associated with a lower occurrence of diabetic macrovascular complications. This result has policy implications for the Korean health care system, in which the delivery system does not work properly.
Summary
Citations
Citations to this article as recorded by
Chasms in Achievement of Recommended Diabetes Care among Geographic Regions in Korea Sanghyun Cho, Ji-Yeon Shin, Hyun Joo Kim, Sang Jun Eun, Sungchan Kang, Won Mo Jang, Hyemin Jung, Yoon Kim, Jin Yong Lee Journal of Korean Medical Science.2019;[Epub] CrossRef
OBJECTIVES The objectives of this study were to estimate the continuity of care for all Koreans with diabetes and to identify factors affecting the continuity of care. METHODS: We obtained National Health Insurance claims data for patients with diabetes who visited health-care providers during the year 2004. A total of 1,498,327 patients were included as study subjects. Most Frequent Provider Continuity (MFPC) and Modified, Modified Continuity Index (MMCI) were used as indexes of continuity of care. A multiple linear regression analysis was used to identify factors affecting continuity of care. RESULTS: The average continuity of care in the entire population of 1,498,327 patients was 0.89+/-0.17 as calculated by MFPC and 0.92+/-0.16 by MMCI. In a multiple linear regression analysis, both MFPC and MMCI were lower for females than males, disabled than non-disabled, Medicaid beneficiaries than health insurance beneficiaries, patients with low monthly insurance contributions, patients in rural residential areas, and patients whose most frequently visited provider is the hospital. CONCLUSIONS: The continuity of care for patients with diabetes is high in Korea. However, women, the disabled and people of low socio-economic status have relatively low continuity of care. Therefore, our first priority is to promote a diabetes management program for these patients.
Summary
Citations
Citations to this article as recorded by
Analysis of Continuity of Care and Its Related Factors in Diabetic Patients: A Cross-Sectional Study Ji Yeh Shin, Ha Jin Kim, BeLong Cho, Yun Jun Yang, Jae Moon Yun Korean Journal of Family Medicine.2022; 43(4): 246. CrossRef
The Role of Continuity of Care in the Management of Chronic Disease Seung-Won Oh Korean Journal of Family Medicine.2022; 43(4): 207. CrossRef
Trends in life expectancy among medical aid beneficiaries and National Health Insurance beneficiaries in Korea between 2004 and 2017 Jinwook Bahk, Hee-Yeon Kang, Young-Ho Khang BMC Public Health.2019;[Epub] CrossRef
The effects of continuity of care on hospital utilization in patients with knee osteoarthritis: analysis of Nationwide insurance data Boyoung Jung, Kyoung Hee Cho, Dong Hyun Lee, Soyoon Kim BMC Health Services Research.2018;[Epub] CrossRef
Association between supplementary private health insurance and visits to physician offices versus hospital outpatient departments among adults with diabetes in the universal public insurance system Chang Hoon You, Ji Heon Choi, Sungwook Kang, Eun-Hwan Oh, Young Dae Kwon, Iratxe Puebla PLOS ONE.2018; 13(4): e0192205. CrossRef
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 Yun Jung Jang, Yoon Soo Choy, Chung Mo Nam, Ki Tae Moon, Eun-Cheol Park BMC Nephrology.2018;[Epub] CrossRef
Use of Western Medicine and Traditional Korean Medicine for Joint Disorders: A Retrospective Comparative Analysis Based on Korean Nationwide Insurance Data Boyoung Jung, Sukjin Bae, Soyoon Kim Evidence-Based Complementary and Alternative Medicine.2017; 2017: 1. CrossRef
Effects of the Continuity of Care on Hospital Utilization : Convergence A Propensity Score Matching Analysis Lee-Su Ahn Journal of Digital Convergence.2015; 13(9): 323. CrossRef
The Quality of Medical Care Provided to Homeless Diabetes Patients in a General Hospital in Seoul, and the Prevalence of Diabetes Comorbidities Sun Hee Beom, Moo Kyung Oh, Chul Woo Ahn Korean Journal of Medicine.2014; 86(5): 585. CrossRef
Continuity of ambulatory care and health outcomes in adult patients with type 2 diabetes in Korea Jae-Seok Hong, Hee-Chung Kang Health Policy.2013; 109(2): 158. CrossRef
The Comparison of Health Status and Health Behavior among Hypertension Group, DM Group, and Hypertension DM Group for the Aged Provided with Customized Home Care Service by Visiting Nurses Hee Kyoung Hyoung, Hyo-Soon Jang Journal of Korean Academy of Community Health Nursing.2011; 22(1): 11. CrossRef
Educational disparities in quality of diabetes care in a universal health insurance system: evidence from the 2005 Korea National Health and Nutrition Examination Survey Y. K. Do, K. N. Eggleston International Journal for Quality in Health Care.2011; 23(4): 397. CrossRef
Group Classification on Management Behavior of Diabetic Mellitus Sung-Hong Kang, Soon-Ho Choi Journal of the Korea Academia-Industrial cooperation Society.2011; 12(2): 765. CrossRef
Continuity of Care for Elderly Patients with Diabetes Mellitus, Hypertension, Asthma, and Chronic Obstructive Pulmonary Disease in Korea Jae Seok Hong, Hee Chung Kang, Jaiyong Kim Journal of Korean Medical Science.2010; 25(9): 1259. CrossRef