Continuity of care for patients with hypertension or diabetes mellitus reduced medical utilization, total medical costs, and cardiovascular events based on the Korean NHIS-HEALS cohort

Abstract

Background and aim: Continuous care of chronic diseases can improve the efficiency of medical system. This study aims to investigate whether continuity of care (CoC) for hypertension or diabetes mellitus (DM) improves medical utilization, costs, and health outcomes, including cardiovascular diseases (CVDs). Methods and results: For this study, 14,246 hypertensive and 9382 diabetic patients aged 60 years or older from the Korean NHIS-HEALS cohort were included. CoC was categorized into three tertiles by disease and sex. Medical utilization and costs were compared using negative binomial regression models and Gamma regression models after adjusting for potential confounders. Cox proportional hazards regression models were constructed to examine the association between the CoC index and the health outcomes (all-cause mortality, CVDs, ischemic heart diseases [IHDs], and cerebrovascular diseases [CbVDs]). In hypertensive patients, hospitalizations decreased across both sexes and emergency room (ER) visits decreased for females with increasing CoC index. Likewise, hospitalizations and medical costs related to DM decreased with increasing CoC index for both sexes. Clinic visits for DM were lowest in T3 group for both sexes. Higher CoC was associated with a lower risk of CVDs, including IHDs and CbVDs, in patients with hypertension or diabetes, as well as with all-cause mortality in patients with diabetes in the fully adjusted model. Conclusions: Continuous care for hypertension or diabetes was inversely associated with medical utilization in patients with hypertension or DM, as well as with medical costs in patients with DM. In addition, CoC decreased CVDs in patients with hypertension or diabetes and reduced all-cause mortality in patients with diabetes.