Ye Ting, Sun Xiaowei, Tang Wenxi, Miao Yudong, Zhang Yan, Zhang Liang
School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, China.
School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China.
BMC Health Serv Res. 2016 Nov 28;16(1):674. doi: 10.1186/s12913-016-1673-2.
Continuity of care is widely considered a principle of primary care that decreases healthcare utilization and mortality. However, the effect of continuity of care on health-related quality of life (HRQoL) for adult patients with hypertension remains unclear.
To further evaluate the effect of continuity of care, we implemented a cohort study among hypertensive patients aged over 35 years (n = 1200) in six townships in Qianjiang District, Chongqing, China, between 2012 and 2014. The study ultimately included 1079 participants. The continuity of care index was calculated using claim-based longitudinal data obtained from hypertension follow-up service records. The baseline and endline survey-based data, tested by the SF-36 scale, were used to assess HRQoL. To control selection bias and examine the effect of continuity of care, a kernel-based propensity score matching difference-in-differences (DID) method was used. Additionally, descriptive statistics, chi-squared test, and Mann-Whitney nonparametric test were used to summarize characteristics, evaluate proportional differences, and analyze statistical differences, respectively.
Our results showed that patients in the high continuity of care group presented greater improvement in both Physical Component Summary (PCS, DID = 5.192 ± 1.970, p < 0.001) and Mental Component Summary (MCS, DID = 7.900 ± 1.815, p = 0.008) than those in the low continuity of care group. Moreover, patients in the high continuity of care group showed significant improvement in physical functioning, role-physical, general health, role-emotional, and mental health.
Our findings indicate that a long-term physician-patient relationship may improve HRQoL in patients with hypertension. However, more unified measurement tools are needed to evaluate continuity of care. Further studies should include more study settings.
连续性医疗被广泛认为是初级医疗的一项原则，可降低医疗利用率和死亡率。然而，连续性医疗对成年高血压患者健康相关生活质量（HRQoL）的影响仍不明确。
为进一步评估连续性医疗的效果，我们于2012年至2014年在中国重庆黔江区的六个乡镇对35岁以上的高血压患者（n = 1200）开展了一项队列研究。该研究最终纳入了1079名参与者。连续性医疗指数是使用从高血压随访服务记录中获得的基于索赔的纵向数据计算得出的。基于SF - 36量表测试的基线和终线调查数据用于评估HRQoL。为控制选择偏倚并检验连续性医疗的效果，我们使用了基于核的倾向得分匹配差异 - 差异（DID）方法。此外，描述性统计、卡方检验和曼 - 惠特尼非参数检验分别用于总结特征、评估比例差异和分析统计差异。
我们的结果表明，高连续性医疗组患者在身体成分总结（PCS，DID = 5.192±1.970，p < 0.001）和心理成分总结（MCS，DID = 7.900±1.815，p = 0.008）方面的改善均大于低连续性医疗组患者。此外，高连续性医疗组患者在身体功能、身体角色、总体健康、情感角色和心理健康方面均有显著改善。
我们的研究结果表明，长期的医患关系可能会改善高血压患者的HRQoL。然而，需要更统一的测量工具来评估连续性医疗。进一步的研究应纳入更多的研究场景。
