Association between team-based continuity of care and risk of cardiovascular diseases among patients with diabetes mellitus a retrospective cohort study

Abstract

Introduction: Cardiovascular diseases (CVD) are a long-term sequela of diabetes mellitus (DM) and better continuity of care (COC) is a potential strategy to reduce the risk of chronic complications. Maintaining a one-to-one patient-physician relationship can be challenging and is often not feasible in public healthcare settings. This study aimed to evaluate the effect of team-based COC, defined as attendance to consultations given by a single physician team, on the development of CVD among DM patients in public clinics. Methods: This was a retrospective cohort study of 316,253 DM patients without CVD who had at least one attendance of physician consultation between 2008-2018. Team-based COC was measured using the Usual Provider Continuity Index (UPCI), which was calculated from the physician team records of all attendance to physician consultation in the two-years prior to baseline. Patients were divided into quartiles based on their UPCI and adjusted using propensity fine stratification weightings. Multivariable cox regression was applied to assess the effect of team-based COC on the development of CVD. Results: After a follow-up of 2,142,492 person-years, the total number of CVD events was 53,272. Compared to patients in the 1st quartile, patients in the 2nd, 3rd and 4th quartiles had a CVD hazard ratio (HR)(95% confidence intervals(CI)) of 0.94(0.92- 0.97); 0.91(0.89-0.94) and 0.86 (0.84-0.89) respectively. Patients with higher team-based COC had lower HRs for various CVD subtypes and mortality. Subgroup analysis found that DM patients who were male, aged 65 or higher or with a Charlson comorbidity index less than 4 received larger benefits from higher team-based COC. Conclusions: Team-based COC is associated with lower CVD risk among DM patients, especially for males, younger patients and those with fewer comorbidities. It will be beneficial to implement team-based COC on the medical care of DM patients.