Relationship between Continuity of Care in the Multidisciplinary Treatment of Patients with Diabetes and Their Clinical Results

Abstract

Multidisciplinary treatment and continuity of care throughout treatment are important for ensuring metabolic control and avoiding complications in diabetic patients. This study examines the relationship between continuity of care of the treating disciplines and clinical evolution of patients. Data from 1836 adult patients experiencing type 2 diabetes mellitus were analyzed, in a period between 12 and 24 months. Continuity was measured by using four well known indices: Usual Provider Continuity (UPC), Continuity of Care Index (COCI), Herfindahl Index (HI), and Sequential Continuity (SECON). Patients were divided into five segments according to metabolic control: well-controlled, worsened, moderately decompensated, highly decompensated, and improved. Well-controlled patients had higher continuity by physicians according to UPC and HI indices (p-values 0.029 and <0.003), whereas highly decompensated patients had less continuity in HI (p-value 0.020). Continuity for nurses was similar, with a greater continuity among well-controlled patients (p-values 0.015 and 0.001 for UPC and HI indices), and less among highly decompensated patients (p-values 0.004 and <0.001 for UPC and HI indices). Improved patients had greater adherence to the protocol than those who worsened. The SECON index showed no significant differences across the disciplines. This study identified a relationship between physicians and nurse’s continuity of care and metabolic control in patients with diabetes, consistent with qualitative findings that highlight the role of nurses in treatment.

Continuity of Care and the Quality of Life among Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study in Taiwan

“…The regression analysis showed that patients’ relationship with providers during hospitalization could predict the QoL of patients with diabetes and explain 4.20% of the variance, and the results showed that the better the relationship with providers during hospitalization, the better the quality of life. The findings were similar to those of previous studies, which found that after discharge, the long-term doctor–patient relationship (interpersonal continuity) reduced mortality and re-admission rate and improved QoL [ 19 , 20 ], but the importance of the ‘relationships with providers during hospitalization’ was more emphasized in this study. Around 25% of patients with diabetes (especially those with comorbidities) may encounter difficulties obtaining CoC, mainly due to the severity of the disease.…”

“…CoC involves the provision of patient-centered medical care via collaborations between medical providers (physicians, nurses, nutritionists, physical therapists, occupational therapists, and pharmacists) to help patients obtain continuous, consistent, and high-quality medical care services [ 17 , 18 ]. Saint-Pierre et al [ 19 ] highlighted the importance of multidisciplinary (physicians, nurses, and nutritionists) intervention and CoC to patient compliance with treatment. In providing continuity of care, medical providers emphasize on information transmission (diagnosis, symptoms, medication, diets, etc.)…”

“…The Patient Continuity of Care Questionnaire (PCCQ) can be used to help professionals understand the nature of continuity of care so they can enable patients with chronic diseases to self-manage their conditions [ 20 ]. CoC facilitates reductions in blood glucose, number of re-admissions, number of urgent consultations, comorbidities, and mortality in patients with diabetes [ 22 ], improving treatment compliance and illness perception [ 19 ].…”

Effects of turnover and stability of health staff on quality of care in remote communities of the Northern Territory, Australia: a retrospective cohort study

“…Short-term staff may focus on acute care needs and neglect or have insufficient awareness of preventive and chronic care needs, such as health promotion, health screening, monitoring chronic health conditions, encouraging smoking cessation or checking the immunisation status of infants and adults. Most, though not all, research shows that continuity of PHC provider is associated with better control of type 2 diabetes [19][20][21][22] as well as increased provision of preventive care services including immunisations and screening for hypertension, alcohol abuse and high cholesterol levels. 23 However, the extent to which continuity of care and measures of staff turnover and stability are associated with quality of care in complex cross-cultural contexts characterised by reliance on short-term PHC providers is not well understood.…”

Data Analytics in Smart Healthcare: The Recent Developments and Beyond

“…In [13], C. Saint-Pierre, F. Prieto, V. Herskovic, and M. Sepúlveda wrote a manuscript "Relationship between continuity of care in the multidisciplinary treatment of patients with diabetes and their clinical results". This paper studied the relationship between continuity of care in the multidisciplinary treatment of type 2 diabetes sufferers and their clinical results.…”