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Continuity of care and delivery of diabetes and hypertensive care among regular users of primary care services in Chile: a cross-sectional study
  1. Javiera Leniz,
  2. Martin C Gulliford
  1. School of Population Health and Environmental Sciences, King’s College London, Faculty of Life Sciences and Medicine, London, UK
  1. Correspondence to Dr Javiera Leniz; javiera.martelli{at}kcl.ac.uk

Abstract

Objectives Explore factors related to continuity of care and its association with diabetes and hypertensive care, and disease control.

Design Cross-sectional study.

Setting Data from the Chilean Health National Survey 2009–2010.

Participants Regular users of primary care services aged 15 or older.

Primary and secondary outcome measures Proportion of hypertensive and diabetic patients with a blood pressure <140/90 mm Hg and HbA1c<7.0% respectively, self-report of diagnosis, treatment and recent foot and ophthalmological exams. Associations between continuity of care, sociodemographic characteristics, and primary and secondary outcomes were explored using logistic regression.

Results 3887 primary care service users were included. 14.7% recognised a usual GP, 82.3% of them knew their name. Continuity of care was positively associated with age >65 years (OR 4.81, 95% CI 3.16 to 7.32), being female (OR 1.66, 95% CI 1.34 to 2.05), retired (OR 2.22, 95% CI 1.75 to 2.83), obese (OR 1.66, 95% CI 1.29 to 2.14), high cardiovascular risk (OR 2.98, 95% CI 2.13 to 4.17) and widowed (OR 1.50, 95% CI 1.13 to 1.99), and negatively associated with educational level (8–12 vs <8 years OR 0.79, 95% CI 0.64 to 0.97), smoking (OR 0.65, 95% CI 0.52 to 0.82) and physical activity (OR 0.76, 95% CI 0.61 to 0.95). Continuity of care was associated with diagnosis awareness (OR 2.83, 95% CI 1.21 to 6.63), pharmacological treatment (OR 2.04, 95% CI 1.15 to 3.63) and a recent foot (OR 3.17, 95% CI 1.84 to 5.45) and ophthalmological exam (OR 3.20, 95% CI 1.66 to 6.18) in diabetic but not in hypertensive patients.

Conclusions Continuity of care was associated with higher odds of having a recent foot and ophthalmological exam in patients with diabetes, but not with better diseases control. Findings suggest patients with chronic conditions have better continuity of care access.

  • continuity of patient care
  • Chronic disease
  • health surveys
  • disease management

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors JL contributed to the design, data analysis, interpretation and writing of first and subsequent drafts of the paper. MCG contributed to the design, data analysis, interpretation and comments on the first and subsequent drafts of the paper.

  • Funding JL was funded by CONICYT, Programa Formacion de Capital Humano Avanzado, Magister Becas Chile, 2015, Folio 73161335.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The Health National Survey 2009–2010 was approved by the Pontifical Catholic University of Chile Ethic Committee and the Ministry of Health on 2009. The authors of the study confirmed that they had guarded the autonomy and confidentiality of patients. The database is anonymised, and therefore there is no access to the identity of the participants. Furthermore, this study does not consider additional data collection. In consideration of that, this study does not require additional ethical approval.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. The data that support the findings of this study are available from the Epidemiology Department, Ministry of Health in Chile but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available.