Dearinger Angela T, Wilson John F, Griffith Charles H, Scutchfield F Douglas
Department of General Internal Medicine, Division of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY, USA.
J Gen Intern Med. 2008 Jul;23(7):937-41. doi: 10.1007/s11606-008-0654-5.
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.
To determine if resident continuity is associated with improvement in diabetic outcomes (HgA1c, LDL, blood pressure) in a resident clinic.
Retrospective analysis of data obtained from a medical record review of diabetic patients seen in a resident physician clinic.
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.
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.
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.
关于连续性对糖尿病护理的影响，存在相互矛盾的数据。住院医师经常在其连续性诊所治疗糖尿病患者；然而，在住院医师诊所维持连续性可能极具挑战性。
确定在住院医师诊所中，住院医师的连续性是否与糖尿病治疗效果（糖化血红蛋白、低密度脂蛋白、血压）的改善相关。
对从住院医师诊所中糖尿病患者的病历审查中获得的数据进行回顾性分析。
我们使用连续性常规提供者指数（UPC）来衡量住院医师和带教教师的连续性。我们测量了三年期间糖化血红蛋白、低密度脂蛋白和血压的变化。使用重复测量方差分析（ANOVA），我们评估了UPC与这些糖尿病治疗效果变化之间的关系。
住院医师的UPC为0.43，带教教师的UPC为0.76。糖化血红蛋白的总体变化为-0.3。糖化血红蛋白的改善与住院医师的UPC之间存在统计学上的显著关系（p = 0.02），但与带教教师的UPC无关。住院医师或带教教师的连续性与低密度脂蛋白或血压的变化之间没有关联。
本研究表明住院医师的连续性与糖尿病患者血糖控制的改善之间存在联系。住院医师有更多机会与患者建立个人关系。这种人际连续性可能对需要大量自我管理行为的疾病患者有益。医学培训项目应致力于改善住院医师初级保健诊所的连续性。
