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The Effect of Physician Continuity on Diabetic Outcomes in a Resident Continuity Clinic

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Abstract

BACKGROUND

Conflicting data exists regarding the effect of continuity on diabetes care. Resident physicians frequently treat patients with diabetes in their continuity clinics; however, maintaining continuity in a resident clinic can be very challenging.

OBJECTIVE

To determine if resident continuity is associated with improvement in diabetic outcomes (HgA1c, LDL, blood pressure) in a resident clinic.

DESIGN AND SETTING

Retrospective analysis of data obtained from a medical record review of diabetic patients seen in a resident physician clinic.

MEASUREMENTS

We measured continuity, using the Usual Provider of Continuity Index (UPC) for residents and faculty preceptors. We measured changes in HgA1c, LDL, and blood pressure over a 3-year period. Using repeated measures analysis of variance (ANOVA), we assessed the relationship between UPC and change in these diabetic outcomes.

RESULTS

The resident UPC was 0.43, and the faculty preceptor UPC was 0.76. The overall change in HgA1c was -0.3. There was a statistically significant relationship between improvement in HgA1c and resident UPC (p = 0.02), but not faculty preceptor UPC. There was no association between resident or faculty preceptor continuity and change in LDL or blood pressure.

CONCLUSION

This study showed a link between resident continuity and improvement in glycemic control in diabetic patients. Resident physicians have a greater opportunity to develop a personal relationship with their patients. This interpersonal continuity may be of benefit in patients with illnesses that requires a significant amount of self-management behaviors. Medical training programs should focus efforts on improving continuity in resident primary care clinics.

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References

  1. Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977–86.

    Article  Google Scholar 

  2. Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research Group. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Eng J Med. 2005;353:2643–53.

    Article  Google Scholar 

  3. UK Prospective Diabetes Study Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1993;352:837–53.

    Google Scholar 

  4. Saaddine JB, Engelgau MM, Beckles GL, Gregg EW, Thompson TJ, Venkat Narayan KM. A diabetes report card for the United States: quality of care in the 1990s. Ann Intern Med. 2002;136:565–74.

    PubMed  Google Scholar 

  5. Saydah SH, Fradkin JF, Cowie CC. Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes. JAMA. 2004;291:335–342.

    Article  CAS  PubMed  Google Scholar 

  6. Saultz JW. Defining and measuring interpersonal continuity of care. Ann Fam Med. 2003;1:134–43.

    Article  PubMed  Google Scholar 

  7. Love M, Talbert J. Continuity of care and the physician-patient relationship. The importance of continuity for adult patients with asthma. J Fam Pract. 2000;49:998–1004.

    CAS  PubMed  Google Scholar 

  8. Wasson JH, Sauvigne AE, Mogielnicki RP, et al.. Continuity of outpatient medical care in elderly men. A randomized trial. JAMA. 1984;252:2413–17.

    Article  CAS  PubMed  Google Scholar 

  9. Parchman ML, Burge SK. Continuity and quality of care in type 2 diabetes: a residency research network of South Texas study. J Fam Pract. 2002;51:619–24.

    PubMed  Google Scholar 

  10. O’Connor PJ, Desai J, Rush WA, Cherney LM, Solberg LI, Bishop DR. Is having a regular provider of diabetes care related to intensity of care and glycemic control. J Fam Pract. 1998;47:290–97.

    CAS  PubMed  Google Scholar 

  11. Parchman ML, Pugh JA, Hitchcock Noel P, Larme AC. Continuity of care, self-management behaviors and glucose control in patients with type 2 diabetes. Med Care. 2002;40:137–44.

    Article  PubMed  Google Scholar 

  12. Manious AG, Koopman RJ, Gill JM, Baker R, Pearson WS. Relationship between continuity of care and diabetes control: evidence from the third National Health and Nutrition Examination Survey. Am J Public Health. 2004;94:66–70.

    Article  Google Scholar 

  13. Gill JM, Manious AG, Diamond JJ, Lenhard MJ. Impact of provider continuity on quality of care for persons with diabetes mellitus. Ann Fam Med. 2003;1:162–70.

    Article  PubMed  Google Scholar 

  14. Nik Sherina H, Teng L, Yasin S. Continuity of care of diabetic patients in a family practice clinic: How important is it. Asia Pacific Family Medicine. 2003;2:10–15.

    Article  Google Scholar 

  15. Irby DM. Teaching and learning in ambulatory settings: a thematic review of the literature. Acad Med. 1995;70:898–931.

    Article  CAS  PubMed  Google Scholar 

  16. Accreditation Council for Graduate Medical Education. Internal Medicine Program Requirements. Available at: http://www.acgme.org/acWebsite/downloads/RRC_progReq/140_im_07012007.pdf Accessed 30 March 2008.

  17. Breslau N, Reeb KG. Continuity of care in a university-based practice. J Med Educ. 1975;50:965–69.

    CAS  PubMed  Google Scholar 

  18. Reid R, Haggerty J, McKendry R. Defusing the Confusion: Concepts and Measures Of Continuity of Health Care. Ottawa, Ontario: Canadian Health Services Research Foundation; 2002.

    Google Scholar 

  19. Swing SR, Vasilias J. Internal medicine residency education in ambulatory settings. Acad Med. 1997;72:988–96.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

There was no research funding or support for this project.

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None disclosed.

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Correspondence to Angela T. Dearinger M.D., M.P.H..

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Dearinger, A.T., Wilson, J.F., Griffith, C.H. et al. The Effect of Physician Continuity on Diabetic Outcomes in a Resident Continuity Clinic. J GEN INTERN MED 23, 937–941 (2008). https://doi.org/10.1007/s11606-008-0654-5

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  • DOI: https://doi.org/10.1007/s11606-008-0654-5

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