Abstract
The aims of the present study were to evaluate the extent of continuity of care and to investigate its association with several factors among a sample of outpatients with chronic diseases in Italy. The survey was conducted, using face to face interview, from March to December 2014 in a random sample of 633 outpatients with chronic conditions who were going in cardiology, metabolic disorders, and respiratory ambulatory center of four hospitals. A multivariate ordered logistic regression model was used to identify factors associated with the outpatients continuity of care. The mean of the Bice-Boxerman continuity of care (COC) index related to the entire sample was 0.44, and 27.9%, 58.4%, 13.7% had a low, intermediate, and high value of the index based on the tertiles of the distribution. The results of the ordered logistic regression analysis showed that female patients, those older, those who had a lower score of Katz Index of independence in activities of daily living, those who had a lower Charlson et al. comorbidity score, and those who had no hospitalization in the last year, were significantly more likely to have a higher value of the COC index. Patients who had completed a secondary school education had significantly lower odds of having a high value of COC index in comparison to patients with a college degree educational level. Policy makers and clinicians involved in the care of patients should implement comprehensively and efficiently efforts in order to improve the continuity of care in patients with chronic diseases.
Highlights
It is widely recognized that continuity of care is an essential element for the delivering of highquality of health care and it is of particular importance for patients with chronic conditions or for those who suffered from multiple comorbidities
The study described here, the first face-to-face questionnaire survey to be performed in Italy, is evaluating the continuity of care in outpatient settings among patients who had chronic diseases and the predisposing and enabling factors to evaluate the determinants of continuity of care
This study population had a higher continuity of care compared with other studies, since the mean COC index (0.44) was higher that the values of 0.31 reported in an observational retrospective cohort group of patients older than 65 years in the United States [30] and of 0.37– 0.39 in a follow-up study in Taiwan in patients who were first diagnosed with type 2 diabetes [16]
Summary
It is widely recognized that continuity of care is an essential element for the delivering of highquality of health care and it is of particular importance for patients with chronic conditions or for those who suffered from multiple comorbidities. Many of these patients require chronic and complex management from a variety of health care professionals in multiple settings and, they are one of the major users of health care services [1,2]. Continuity of care could result in a reduction of health care costs with reducing fragmentation of care of the patients, better outcomes for their diseases, and a higher level of their satisfaction [6,7,8,9,10,11,12,13]
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