Faculty of Health Sciences, Department of Community Medicine, UiT The Arctic University of Norway and University Hospital of North Norway, Tromsø, Norway.
Faculty of Health Sciences, Department of Community Medicine, Research Unit for General Practice, UiT The Arctic University of Norway, Tromsø, Norway.
PLoS One. 2022 Oct 25;17(10):e0276054. doi: 10.1371/journal.pone.0276054. eCollection 2022.
Continuity of care is particularly important for patients with chronic conditions, such as type 2 diabetes (T2D). Continuity is shown to reduce overall health service utilization among people with diabetes, however, evidence about how it relates to the utilization of outpatient specialist services in Norway is lacking. The aim of this study was to investigate continuity of GP care for people with T2D, and its association with the use of outpatient specialist health care services.
We used e-mail questionnaire data obtained from members of The Norwegian Diabetes Association in 2018. Eligible for analyses were 494 respondents with T2D and at least one GP visit during the previous year. By descriptive statistics and logistic regressions, we studied usual provider continuity (UPC) and duration of the patient-GP relationship and associations of these measures with somatic outpatient specialist visits. Analyses were adjusted for gender, age, education, self-rated health, and diabetes duration.
Mean age was 62.6 years and mean UPC was 0.85 (CI 0.83-0.87). Two thirds of the sample (66.0%) had made all visits to the regular GP during the previous year (full continuity). Among these, 48.1% had made one or more specialist visits during the previous year, compared to 65.2% among those without full continuity. The probability of outpatient specialist visits was significantly lower among participants with full continuity, compared to those without full continuity (Odds Ratio 0.53, Confidence Interval 0.35-0.80). The probability of visiting outpatient specialist services was not associated with duration of the patient-GP relationship.
We conclude that continuity of care, as measured by Usual Provider Continuity, is high and associated with reduced use of somatic outpatient specialist services in people with T2D in Norway. Continuity and its benefits will become increasingly important as the number of older people with diabetes and other chronic diseases increases.
连续性护理对于患有慢性疾病（如 2 型糖尿病（T2D））的患者尤为重要。有证据表明，连续性护理可降低糖尿病患者的整体卫生服务利用率，然而，挪威缺乏关于其与门诊专科服务利用之间关系的证据。本研究旨在调查 T2D 患者的全科医生护理连续性及其与门诊专科卫生保健服务利用之间的关系。
我们使用了 2018 年从挪威糖尿病协会成员处获得的电子邮件问卷调查数据。符合分析条件的是 494 名在过去一年中有 T2D 且至少有一次全科医生就诊的患者。通过描述性统计和逻辑回归，我们研究了常用提供者连续性（UPC）和患者与全科医生关系的持续时间，以及这些措施与躯体门诊专科就诊之间的关联。分析调整了性别、年龄、教育程度、自我评估健康状况和糖尿病持续时间。
平均年龄为 62.6 岁，平均 UPC 为 0.85（CI 0.83-0.87）。三分之二的样本（66.0%）在过去一年中一直看常规全科医生（完全连续性）。在这些患者中，48.1%在过去一年中看过一次或多次专科医生，而在没有完全连续性的患者中，这一比例为 65.2%。与没有完全连续性的患者相比，具有完全连续性的患者门诊专科就诊的可能性显著降低（优势比 0.53，置信区间 0.35-0.80）。与患者与全科医生关系的持续时间无关。
我们的结论是，以常用提供者连续性衡量的护理连续性在挪威 T2D 患者中较高，与躯体门诊专科服务利用率降低相关。随着患有糖尿病和其他慢性病的老年人数量的增加，连续性及其益处将变得越来越重要。
