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/m(2), 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.