Associations between the continuity of ambulatory care of adult diabetes patients in Korea and the incidence of microvascular complications

Young Hoon Gong, Seok-Jun Yoon, Hyeyoung Seo, Dongwoo Kim

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objectives: The goal of this study was to identify association between the continuity of ambulatory care of diabetes patients in South Korea (hereafter Korea) and the incidence of macrovascular complications of diabetes, using claims data compiled by the National Health Insurance Services of Korea. Methods: This study was conducted retrospectively. The subjects of the study were 43 002 patients diagnosed with diabetes in 2007, who were over 30 years of age, and had insurance claim data from 2008. The macrovascular complications of diabetes mellitus were limited to ischemic heart disease and ischemic stroke. We compared the characteristics of the patients in whom macrovascular complications occurred from 2009 to 2012 to the characteristics of the patients who had no such complications. Multiple logistic regression was used to assess the effects of continuity of ambulatory care on diabetic macrovascular complications. The continuity of ambulatory diabetes care was estimated by metrics such as the medication possession ratio, the quarterly continuity of care and the number of clinics that were visited. Results: Patients with macrovascular complications showed statistically significant differences regarding sex, age, comorbidities, hypertension, dyslipidemia and continuity of ambulatory diabetes care. Visiting a lower number of clinics reduced the odds ratio for macrovascular complications of diabetes. A medication possession ratio below 80% was associated with an increased odds ratio for macrovascular complications, but this result was of borderline statistical significance. Conclusions: Diabetes care by regular health care providers was found to be associated with a lower occurrence of diabetic macrovascular complications. This result has policy implications for the Korean health care system, in which the delivery system does not work properly.

Original languageEnglish
Pages (from-to)188-194
Number of pages7
JournalJournal of Preventive Medicine and Public Health
Volume48
Issue number4
DOIs
Publication statusPublished - 2015 Jan 1

Fingerprint

Continuity of Patient Care
Diabetes Complications
Korea
Ambulatory Care
Incidence
National Health Programs
Odds Ratio
Republic of Korea
Dyslipidemias
Insurance
Sex Characteristics
Health Personnel
Myocardial Ischemia
Comorbidity
Logistic Models
Stroke
Hypertension
Delivery of Health Care

Keywords

  • Continuity of care
  • Diabetes complications
  • Diabetes mellitus
  • Primary health care

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Associations between the continuity of ambulatory care of adult diabetes patients in Korea and the incidence of microvascular complications. / Gong, Young Hoon; Yoon, Seok-Jun; Seo, Hyeyoung; Kim, Dongwoo.

In: Journal of Preventive Medicine and Public Health, Vol. 48, No. 4, 01.01.2015, p. 188-194.

Research output: Contribution to journalArticle

@article{0c04c51af6e14325bf41338258ec7d83,
title = "Associations between the continuity of ambulatory care of adult diabetes patients in Korea and the incidence of microvascular complications",
abstract = "Objectives: The goal of this study was to identify association between the continuity of ambulatory care of diabetes patients in South Korea (hereafter Korea) and the incidence of macrovascular complications of diabetes, using claims data compiled by the National Health Insurance Services of Korea. Methods: This study was conducted retrospectively. The subjects of the study were 43 002 patients diagnosed with diabetes in 2007, who were over 30 years of age, and had insurance claim data from 2008. The macrovascular complications of diabetes mellitus were limited to ischemic heart disease and ischemic stroke. We compared the characteristics of the patients in whom macrovascular complications occurred from 2009 to 2012 to the characteristics of the patients who had no such complications. Multiple logistic regression was used to assess the effects of continuity of ambulatory care on diabetic macrovascular complications. The continuity of ambulatory diabetes care was estimated by metrics such as the medication possession ratio, the quarterly continuity of care and the number of clinics that were visited. Results: Patients with macrovascular complications showed statistically significant differences regarding sex, age, comorbidities, hypertension, dyslipidemia and continuity of ambulatory diabetes care. Visiting a lower number of clinics reduced the odds ratio for macrovascular complications of diabetes. A medication possession ratio below 80{\%} was associated with an increased odds ratio for macrovascular complications, but this result was of borderline statistical significance. Conclusions: Diabetes care by regular health care providers was found to be associated with a lower occurrence of diabetic macrovascular complications. This result has policy implications for the Korean health care system, in which the delivery system does not work properly.",
keywords = "Continuity of care, Diabetes complications, Diabetes mellitus, Primary health care",
author = "Gong, {Young Hoon} and Seok-Jun Yoon and Hyeyoung Seo and Dongwoo Kim",
year = "2015",
month = "1",
day = "1",
doi = "10.3961/jpmph.15.020",
language = "English",
volume = "48",
pages = "188--194",
journal = "Journal of Preventive Medicine and Public Health",
issn = "1975-8375",
publisher = "Korean Society for Preventive Medicine",
number = "4",

}

TY - JOUR

T1 - Associations between the continuity of ambulatory care of adult diabetes patients in Korea and the incidence of microvascular complications

AU - Gong, Young Hoon

AU - Yoon, Seok-Jun

AU - Seo, Hyeyoung

AU - Kim, Dongwoo

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Objectives: The goal of this study was to identify association between the continuity of ambulatory care of diabetes patients in South Korea (hereafter Korea) and the incidence of macrovascular complications of diabetes, using claims data compiled by the National Health Insurance Services of Korea. Methods: This study was conducted retrospectively. The subjects of the study were 43 002 patients diagnosed with diabetes in 2007, who were over 30 years of age, and had insurance claim data from 2008. The macrovascular complications of diabetes mellitus were limited to ischemic heart disease and ischemic stroke. We compared the characteristics of the patients in whom macrovascular complications occurred from 2009 to 2012 to the characteristics of the patients who had no such complications. Multiple logistic regression was used to assess the effects of continuity of ambulatory care on diabetic macrovascular complications. The continuity of ambulatory diabetes care was estimated by metrics such as the medication possession ratio, the quarterly continuity of care and the number of clinics that were visited. Results: Patients with macrovascular complications showed statistically significant differences regarding sex, age, comorbidities, hypertension, dyslipidemia and continuity of ambulatory diabetes care. Visiting a lower number of clinics reduced the odds ratio for macrovascular complications of diabetes. A medication possession ratio below 80% was associated with an increased odds ratio for macrovascular complications, but this result was of borderline statistical significance. Conclusions: Diabetes care by regular health care providers was found to be associated with a lower occurrence of diabetic macrovascular complications. This result has policy implications for the Korean health care system, in which the delivery system does not work properly.

AB - Objectives: The goal of this study was to identify association between the continuity of ambulatory care of diabetes patients in South Korea (hereafter Korea) and the incidence of macrovascular complications of diabetes, using claims data compiled by the National Health Insurance Services of Korea. Methods: This study was conducted retrospectively. The subjects of the study were 43 002 patients diagnosed with diabetes in 2007, who were over 30 years of age, and had insurance claim data from 2008. The macrovascular complications of diabetes mellitus were limited to ischemic heart disease and ischemic stroke. We compared the characteristics of the patients in whom macrovascular complications occurred from 2009 to 2012 to the characteristics of the patients who had no such complications. Multiple logistic regression was used to assess the effects of continuity of ambulatory care on diabetic macrovascular complications. The continuity of ambulatory diabetes care was estimated by metrics such as the medication possession ratio, the quarterly continuity of care and the number of clinics that were visited. Results: Patients with macrovascular complications showed statistically significant differences regarding sex, age, comorbidities, hypertension, dyslipidemia and continuity of ambulatory diabetes care. Visiting a lower number of clinics reduced the odds ratio for macrovascular complications of diabetes. A medication possession ratio below 80% was associated with an increased odds ratio for macrovascular complications, but this result was of borderline statistical significance. Conclusions: Diabetes care by regular health care providers was found to be associated with a lower occurrence of diabetic macrovascular complications. This result has policy implications for the Korean health care system, in which the delivery system does not work properly.

KW - Continuity of care

KW - Diabetes complications

KW - Diabetes mellitus

KW - Primary health care

UR - http://www.scopus.com/inward/record.url?scp=84938843328&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84938843328&partnerID=8YFLogxK

U2 - 10.3961/jpmph.15.020

DO - 10.3961/jpmph.15.020

M3 - Article

VL - 48

SP - 188

EP - 194

JO - Journal of Preventive Medicine and Public Health

JF - Journal of Preventive Medicine and Public Health

SN - 1975-8375

IS - 4

ER -