Background Continuity of care in primary care settings is crucial for managing diabetes. We aimed to statistically define and analyze continuity factors associated with demographics, clinical workforce, and geographical relationships.
Methods We used 2014–2015 National Health Insurance Service claims data from the Korean registry, with 39,096 eligible outpatient attendance. We applied multivariable logistic regression to analyze factors that may affect the continuity of care indices for each patient: the most frequent provider continuity index (MFPCI), modified-modified continuity index (MMCI), and continuity of care index (COCI).
Results The mean continuity of care indices were 0.90, 0.96, and 0.85 for MFPCI, MMCI and COCI, respectively. Among patient factors, old age >80 years (MFPCI: odds ratio [OR], 0.81; 95% confidence interval [CI], 0.74–0.89; MMCI: OR, 0.84; 95% CI, 0.76–0.92; and COCI: OR, 0.81; 95% CI, 0.74–0.89) and mild disability were strongly associated with lower continuity of care. Another significant factor was the residential area: the farther the patients lived from their primary care clinic, the lower the continuity of diabetes care (MFPCI: OR, 0.74; 95% CI, 0.70–0.78; MMCI: OR, 0.70; 95% CI, 0.66–0.73; and COCI: OR, 0.74; 95% CI, 0.70–0.78).
Conclusion The geographical proximity of patients’ residential areas and clinic locations showed the strongest correlation as a continuity factor. Further efforts are needed to improve continuity of care to address the geographical imbalance in diabetic care.
Citations
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A Systematic Review of Continuity of Care Strategies for Enhancing Diabetes Self-Management in Older Adults in Asian Countries Citra Sari, Hartiah Haroen, Neti Juniarti, Lisda Amalia, Jerico Pardosi Journal of Multidisciplinary Healthcare.2025; Volume 18: 5441. CrossRef
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Background In the Republic of Korea, which medical specialties should take the responsibility for primary care and what the role of primary care should be are still unclear. In this study, we focused on the comprehensiveness of primary care to identify related factors.
Methods The National Health Insurance Service (NHIS)-National Sample Cohort is a population-based cohort, sampled in the 2002 NHIS database and followed up until 2015. We used data collected from January 2014 to December 2015, including 20,423,832 outpatient visits in 19,557 office-based clinics. The Korean government has designated 52 simple or minor disease groups (SMDGs) to enhance the experience of patients who attend primary care for managing those diseases. We assessed comprehensiveness for each clinic as the number of SMDGs treated in each clinic for 2 years. We also identified the factors related to higher comprehensiveness, using logistic regression for analysis.
Results The clinics included in the study had provided treatment for an average of 14 SMDGs during a 2-year period. Compared to general practitioners, internal medicine physicians presented higher comprehensiveness with an odds ratio (OR) of 2.29 (95% confidence interval [CI], 2.03–2.59), and family medicine physicians illustrated higher comprehensiveness (OR, 4.96; 95% CI, 3.59–6.83). Other specialties showed lower comprehensiveness than general practitioners. Clinics located in the capital city and metropolitan area tended to have lower comprehensiveness. Clinics hiring more doctors and having hospitalization facility showed higher comprehensiveness.
Conclusion General physician, internal medicine, and family medicine are the fields providing comprehensive medical care in Korea. Clinics located in metropolitan area and capital city show lower comprehensiveness. The number of physicians is related to higher comprehensiveness of clinics.
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