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The relationship between type 2 diabetic patients' early medical care-seeking consistency to the same clinician and health care system and their clinical outcomes.

Liao PJ, Lin ZY, Huang JC, Hsu KH - Medicine (Baltimore) (2015)

Bottom Line: The occurrence of diabetes-related complications and all-cause mortality were the primary outcomes of this study.Chi-square tests, ANOVAs, and Cox proportional hazard models were applied to examine the relationships between the predictors and medical outcomes.The monotonic trend was sustained across different strata of age, gender, and disease complexity.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Health Care Administration (PJL), Oriental Institute of Technology, New Taipei City; Department of Health Care Management (ZYL), Chang Gung University, Taoyuan; Division of Endocrinology & Metabolism (JCH), Department of Internal Medicine, Chang Gung Memorial Hospital, Yunlin; and Laboratory for Epidemiology (KHH), Department of Health Care Management, and Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.

ABSTRACT
The literature has demonstrated that the continuity of diabetes care can lower medical service utilization and expenses. However, few studies have examined the effects of patients' medical care-seeking behaviors in the early stage after the diagnosis of diabetes on their long-term prognoses. This study aimed to examine the association of medical care-seeking behavior in the first year following diabetes diagnosis on the occurrence of diabetes-related complications among patients in Taiwan. This is a retrospective data collection with follow-up analysis and a nationwide population-based dataset in Taiwan. A total of 89,428 newly diagnosed type 2 diabetes mellitus patients during the period from 2000 to 2006 were followed up until 2010. The patients' medical care-seeking behaviors were classified as follows: high consistency to a physician, high consistency to a medical setting, medium consistency to providers, and low consistency to providers. The occurrence of diabetes-related complications and all-cause mortality were the primary outcomes of this study. Chi-square tests, ANOVAs, and Cox proportional hazard models were applied to examine the relationships between the predictors and medical outcomes. Compared to the patients with high medical care-seeking consistency to a physician, the multivariate-adjusted hazard ratios of diabetes-related complications occurrence among patients in the high consistency to a medical setting, medium consistency, and low consistency categories were 1.112 (95% CI 1.089-1.136, P < 0.001), 1.226 (95% CI 1.205-1.248, P < 0.001), and 1.536 (95% CI 1.504-1.567, P < 0.001) in outpatient visits and 1.032 (95% CI 0.992-1.074, P = 0.121), 1.056 (95% CI 1.022-1.092, P = 0.001), and 1.208 (95% CI 1.164-1.254, P < 0.001) in complication-incurred hospitalizations, respectively. The monotonic trend was sustained across different strata of age, gender, and disease complexity. The findings of this study suggest that the incentives of continuity of care and physician-patient relationship management should be reinforced during the early stage of diabetes care in future medical care systems.

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Related in: MedlinePlus

Multivariate-adjusted survivals among the 4 medical care–seeking behavior groups∗. ∗P < 0.001, test for monotonic trend (from high medical care–seeking consistency to a physician to low medical care–seeking consistency) performed by Cox proportional hazard model that was adjusted for variables including the physicians’ genders, physicians’ ages, physicians’ years of practice since acquiring a specialty license, accreditation level of the primary outpatient visit medical setting, area of the medical setting, patients’ genders, patients’ ages, patients’ number of diagnoses, primary outpatient visit department, and whether complications occurred.
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Figure 1: Multivariate-adjusted survivals among the 4 medical care–seeking behavior groups∗. ∗P < 0.001, test for monotonic trend (from high medical care–seeking consistency to a physician to low medical care–seeking consistency) performed by Cox proportional hazard model that was adjusted for variables including the physicians’ genders, physicians’ ages, physicians’ years of practice since acquiring a specialty license, accreditation level of the primary outpatient visit medical setting, area of the medical setting, patients’ genders, patients’ ages, patients’ number of diagnoses, primary outpatient visit department, and whether complications occurred.

Mentions: Stratified analyses revealed a significantly elevated risk of developing outpatient complications among the low consistency to a provider group regardless of gender, age group, number of secondary diagnoses, or department of the outpatient visit (Table 3). All strata exhibited dose-response relationships between medical care–seeking behavior (from high consistency to low consistency) and the occurrence of outpatient complications (Table 3). The greatest likelihood of developing complication incurred hospitalization was also found among the patients with low consistency to a provider across all strata regardless of gender, age group, number of secondary diagnoses, and department of the outpatient visit (Table 4). Figure 1 illustrates the all-cause mortality survival curves during the study period for the 4 medical care–seeking behavior groups following adjustments for all of the other study variables. A monotonic trend was observed between decreasing consistency in medical care–seeking behavior (from high consistency to low consistency) and decreasing multivariate-adjusted survival (P < 0.001, test for monotonic trend) (Figure 1).


The relationship between type 2 diabetic patients' early medical care-seeking consistency to the same clinician and health care system and their clinical outcomes.

Liao PJ, Lin ZY, Huang JC, Hsu KH - Medicine (Baltimore) (2015)

Multivariate-adjusted survivals among the 4 medical care–seeking behavior groups∗. ∗P < 0.001, test for monotonic trend (from high medical care–seeking consistency to a physician to low medical care–seeking consistency) performed by Cox proportional hazard model that was adjusted for variables including the physicians’ genders, physicians’ ages, physicians’ years of practice since acquiring a specialty license, accreditation level of the primary outpatient visit medical setting, area of the medical setting, patients’ genders, patients’ ages, patients’ number of diagnoses, primary outpatient visit department, and whether complications occurred.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554162&req=5

Figure 1: Multivariate-adjusted survivals among the 4 medical care–seeking behavior groups∗. ∗P < 0.001, test for monotonic trend (from high medical care–seeking consistency to a physician to low medical care–seeking consistency) performed by Cox proportional hazard model that was adjusted for variables including the physicians’ genders, physicians’ ages, physicians’ years of practice since acquiring a specialty license, accreditation level of the primary outpatient visit medical setting, area of the medical setting, patients’ genders, patients’ ages, patients’ number of diagnoses, primary outpatient visit department, and whether complications occurred.
Mentions: Stratified analyses revealed a significantly elevated risk of developing outpatient complications among the low consistency to a provider group regardless of gender, age group, number of secondary diagnoses, or department of the outpatient visit (Table 3). All strata exhibited dose-response relationships between medical care–seeking behavior (from high consistency to low consistency) and the occurrence of outpatient complications (Table 3). The greatest likelihood of developing complication incurred hospitalization was also found among the patients with low consistency to a provider across all strata regardless of gender, age group, number of secondary diagnoses, and department of the outpatient visit (Table 4). Figure 1 illustrates the all-cause mortality survival curves during the study period for the 4 medical care–seeking behavior groups following adjustments for all of the other study variables. A monotonic trend was observed between decreasing consistency in medical care–seeking behavior (from high consistency to low consistency) and decreasing multivariate-adjusted survival (P < 0.001, test for monotonic trend) (Figure 1).

Bottom Line: The occurrence of diabetes-related complications and all-cause mortality were the primary outcomes of this study.Chi-square tests, ANOVAs, and Cox proportional hazard models were applied to examine the relationships between the predictors and medical outcomes.The monotonic trend was sustained across different strata of age, gender, and disease complexity.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Health Care Administration (PJL), Oriental Institute of Technology, New Taipei City; Department of Health Care Management (ZYL), Chang Gung University, Taoyuan; Division of Endocrinology & Metabolism (JCH), Department of Internal Medicine, Chang Gung Memorial Hospital, Yunlin; and Laboratory for Epidemiology (KHH), Department of Health Care Management, and Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.

ABSTRACT
The literature has demonstrated that the continuity of diabetes care can lower medical service utilization and expenses. However, few studies have examined the effects of patients' medical care-seeking behaviors in the early stage after the diagnosis of diabetes on their long-term prognoses. This study aimed to examine the association of medical care-seeking behavior in the first year following diabetes diagnosis on the occurrence of diabetes-related complications among patients in Taiwan. This is a retrospective data collection with follow-up analysis and a nationwide population-based dataset in Taiwan. A total of 89,428 newly diagnosed type 2 diabetes mellitus patients during the period from 2000 to 2006 were followed up until 2010. The patients' medical care-seeking behaviors were classified as follows: high consistency to a physician, high consistency to a medical setting, medium consistency to providers, and low consistency to providers. The occurrence of diabetes-related complications and all-cause mortality were the primary outcomes of this study. Chi-square tests, ANOVAs, and Cox proportional hazard models were applied to examine the relationships between the predictors and medical outcomes. Compared to the patients with high medical care-seeking consistency to a physician, the multivariate-adjusted hazard ratios of diabetes-related complications occurrence among patients in the high consistency to a medical setting, medium consistency, and low consistency categories were 1.112 (95% CI 1.089-1.136, P < 0.001), 1.226 (95% CI 1.205-1.248, P < 0.001), and 1.536 (95% CI 1.504-1.567, P < 0.001) in outpatient visits and 1.032 (95% CI 0.992-1.074, P = 0.121), 1.056 (95% CI 1.022-1.092, P = 0.001), and 1.208 (95% CI 1.164-1.254, P < 0.001) in complication-incurred hospitalizations, respectively. The monotonic trend was sustained across different strata of age, gender, and disease complexity. The findings of this study suggest that the incentives of continuity of care and physician-patient relationship management should be reinforced during the early stage of diabetes care in future medical care systems.

Show MeSH
Related in: MedlinePlus