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BMC Fam Pract. 2018 Jul 30;19(1):132. doi: 10.1186/s12875-018-0823-5.

Interpersonal continuity of primary care of veterans with diabetes: a cohort study using electronic health record data.

Author information

1
Duke University School of Medicine, Physician Assistant Program|, 800 South Duke Street, Durham, NC, 27701, USA. Christine.everett@duke.edu.
2
Duke University School of Medicine, Physician Assistant Program|, 800 South Duke Street, Durham, NC, 27701, USA.
3
Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.
4
Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
5
Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA.
6
Clinical Health Systems & Analytics Division, Duke University School of Nursing, Durham, NC, USA.

Abstract

BACKGROUND:

Continuity of care is a cornerstone of primary care and is important for patients with chronic diseases such as diabetes. The study objective was to examine patient, provider and contextual factors associated with interpersonal continuity of care (ICoC) among Veteran's Health Administration (VHA) primary care patients with diabetes.

METHODS:

This patient-level cohort study (N = 656,368) used electronic health record data of adult, pharmaceutically treated patients (96.5% male) with diabetes at national VHA primary care clinics in 2012 and 2013. Each patient was assigned a "home" VHA facility as the primary care clinic most frequently visited, and a primary care provider (PCP) within that home clinic who was most often seen. Patient demographic, medical and social complexity variables, provider type, and clinic contextual variables were utilized. We examined the association of ICoC, measured as maintaining the same PCP across both years, with all variables simultaneously using logistic regression fit with generalized estimating equations.

RESULTS:

Among VHA patients with diabetes, 22.3% switched providers between 2012 and 2013. Twelve patient, two provider and two contextual factors were associated with ICoC. Patient characteristics associated with disruptions in ICoC included demographic factors, medical complexity, and social challenges (example: homeless at any time during the year OR = 0.79, CI = 0.75-0.83). However, disruption in ICoC was most likely experienced by patients whose providers left the clinic (OR = 0.09, CI = 0.07-0.11). One contextual factor impacting ICoC included NP regulation (most restrictive NP regulation (OR = 0.79 CI = 0.69-0.97; reference least restrictive regulation).

CONCLUSIONS:

ICoC is an important mechanism for the delivery of quality primary care to patients with diabetes. By identifying patient, provider, and contextual factors that impact ICoC, this project can inform the development of interventions to improve continuity of chronic illness care.

KEYWORDS:

Continuity of care; Diabetes; Primary care

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