2型糖尿病患者的连续性护理与死亡率：一项队列研究。

Continuity of care and mortality in patients with type 2 diabetes: a cohort study.

作者信息

Mellanen Eero H, Kauppila Timo, Kautiainen Hannu, Lehto Mika T, Rahkonen Ossi, Pitkälä Kaisu H, Laine Merja K

机构信息

Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland

Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

出版信息

BJGP Open. 2025 Apr 24;9(1). doi: 10.3399/BJGPO.2024.0144. Print 2025 Apr.

DOI:10.3399/BJGPO.2024.0144

PMID:39197879

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12138002/

Abstract

BACKGROUND

How GP continuity of care (GP-CoC) affects mortality in patients with type 2 diabetes (T2D) is unclear.

AIM

To examine the effect of having no continuity of care (CoC) and GP-CoC on mortality in primary health care (PHC) patients with T2D.

DESIGN & SETTING: A cohort study in patients aged ≥60 years with T2D, which was conducted within the public PHC of the city of Vantaa, Finland.

METHOD

The inclusion period was between 2002 and 2011 and follow-up period between 2011 and 2018. Six groups were formed (no appointments, one appointment and Modified, Modified Continuity Index [MMCI] quartiles). Mortality was measured with standardised mortality ratio (SMR) and adjusted hazard ratio (aHR). GP-CoC was measured with MMCI. Comorbidity status was determined with Charlson Comorbidity Index (CCI).

RESULTS

In total, 11 020 patients were included. Mean follow-up time was 7.3 years. SMRs for the six groups (no appointments, one appointment, MMCI quartiles) were 2.46 (95% confidence interval [CI] = 2.24 to 2.71), 3.55 (95% CI = 3.05 to 4.14), 1.15 (95% CI = 1.06 to 1.25), 0.97 (95% CI = 0.89 to 1.06), 0.92 (95% CI = 0.84 to 1.01) and 1.21 (95% CI = 1.11 to 1.31), respectively. With continuous MMCI, mortality formed a U-curve. The inflection point was at a MMCI value of 0.65 with corresponding SMR of 0.86. Age and CCI aHR for death between men and women was 1.45 (95% CI = 1.35 to 1.58).

CONCLUSION

Patients with no CoC had the highest mortality. In patients having care over time, the effect of GP-CoC on mortality was minor and mortality increased with high GP-CoC.

摘要

背景

全科医生连续性照护（GP-CoC）如何影响2型糖尿病（T2D）患者的死亡率尚不清楚。

目的

研究无连续性照护（CoC）和GP-CoC对初级卫生保健（PHC）中T2D患者死亡率的影响。

设计与背景

一项针对年龄≥60岁的T2D患者的队列研究，在芬兰万塔市的公共初级卫生保健机构内开展。

方法

纳入期为2002年至2011年，随访期为2011年至2018年。分为六组（无预约、一次预约以及改良连续性指数[MMCI]四分位数分组）。死亡率通过标准化死亡比（SMR）和调整后风险比（aHR）衡量。GP-CoC通过MMCI衡量。合并症状态通过查尔森合并症指数（CCI）确定。

结果

共纳入11020例患者。平均随访时间为7.3年。六组（无预约、一次预约、MMCI四分位数分组）的SMR分别为2.46（95%置信区间[CI]=2.24至2.71）、3.55（95%CI=3.05至4.14）、1.15（95%CI=1.06至1.25）、0.97（95%CI=0.89至1.06）、0.92（95%CI=0.84至1.01）和1.21（95%CI=1.11至1.31）。随着MMCI连续变化，死亡率呈U型曲线。拐点处的MMCI值为0.65，对应的SMR为0.86。年龄和CCI的死亡aHR在男性和女性之间为1.45（95%CI=1.35至1.58）。