Association Between Team-Based Continuity of Care and Risk of Cardiovascular Diseases Among Patients With Diabetes: A Retrospective Cohort Study

Abstract

<b>Background</b> <p>Cardiovascular diseases (CVD) are a long-term sequela of diabetes mellitus. Better individual-based continuity of care has been reported to reduce the risk of chronic complications among patients with diabetes mellitus. Maintaining a one-to-one patient-physician relationship is often challenging, especially in public healthcare settings. This study aimed to evaluate the relationship between higher team-based continuity of care, defined as consultations provided by the same physician team, and CVD risks in patients with diabetes mellitus from public primary care clinics.</p> <p><b>Study design</b></p> <p>This was a retrospective cohort study in Hong Kong of 312,068 patients with type 2 diabetes mellitus and without any history of CVD at baseline (defined as the earliest attendance at a doctor’s consultation in a public-sector clinic between 2008-2018). Team-based continuity of care was measured using the usual provider continuity index (UPCI), calculated by the proportion of consultations provided by the most visited physician team in the two years before baseline. Patients were divided into quartiles based on their UPCI, and the characteristics of the quartiles were balanced using propensity fine stratification weightings. Multivariable Cox regression was applied to assess the effect of team-based continuity of care on CVD incidence. Patient demographics, smoking status, physiological measurements, number of attendances, comorbidities, and medications were adjusted for in the propensity weightings and regression analyses. </p> <p><b>Result</b></p> <p>After an average follow-up of 6.5 years, the total number of new CVD events was 52,428. Compared to patients in the 1<sup>st</sup> quartile, patients in the 2<sup>nd</sup>, 3<sup>rd</sup> and 4<sup>th</sup> quartiles of the UCPI had a CVD hazard ratio (HR) (95% confidence intervals) of 0.95 (0.92-0.97); 0.92 (0.89-0.94) and 0.87 (0.84-0.89) respectively, indicating that higher continuity of care was associated with lower CVD risks. The subtypes of CVD, including coronary heart disease and stroke, also showed a similar pattern. Subgroup analyses suggested that patients younger than 65 years had greater benefits from higher team-based continuity of care.</p> <p><b>Conclusion</b></p> <p>Team-based continuity of care was associated with lower CVD risk among individuals with type 2 diabetes mellitus, especially those that were younger. This suggests a potential flexible alternative implementation of continuity of care in public clinics. </p>