The Impact of Continuity of Care on Health Indicators in Patients With Type 2 Diabetes Mellitus in Family Medicine Clinics in Riyadh.

BACKGROUND: Diabetes Mellitus Type 2 (DM2) is highly prevalent in Saudi Arabia, with many experiencing complications due to the disease. Family medicine physicians are usually the primary care providers responsible for the medical management of type 2 diabetes mellitus patients. Microvascular and macrovascular complications can occur if type 2 diabetes mellitus is poorly managed. Effective management of health indicators in patients with DM2 relating to glycated hemoglobin (HbA1c), low density lipoprotein cholesterol, blood pressure, and tobacco use is an essential part of medical care to prevent complications. Due to the projected increase in the number of patients with DM2, there is huge concern surrounding the management of this chronic illness that requires review. This study aims to evaluate the impact of continuity of care on health indicators among family medicine patients diagnosed with diabetes mellitus type 2 and to analyze the effect of continuity of care regarding the completion of age-appropriate preventive health screenings. METHODS:  This is a retrospective cohort study. Data collected from electronic medical records of patients 40-75 years of age that received care at the Family Medicine clinics that were diagnosed with type 2 diabetes mellitus with ≥4 clinic visits from January 1, 2017, to June 30, 2020, at King Faisal Specialist Hospital & Research Centre in Riyadh, Saudi Arabia. Data collected included demographic data, body mass index, smoking status, blood pressure, past medical history, preventive health screening completed, and laboratory results, including HbA1c and lipid profile. The continuity of care index and usual provider continuity score indices were calculated for the analysis to measure continuity of care. RESULTS:  Three hundred and fifty-two patients were included in the study. Most of the patients were Saudi (74.15%), female (51.99%), and married (82.67%). In addition, 90.34% accounted for a high usual provider continuity of care score (UPCS), and 64.20% of the patients had a high continuity of care index (COCi). Younger age groups were significantly more prevalent in the high UPCS group (p=0.037). Additionally, patients of non-Saudi nationalities constituted a significantly larger proportion of the high UPCS group. Single patients showed high UPCS. Comorbidities were not different between the groups, except inflammatory joint disease, which was more common in the low COCi group. Preventative screening measures were also not different between the groups; however, the type of colon cancer screening differed, where patients with high COCi more frequently underwent colonoscopies (13.3% vs. 4.4%, p=0.015) instead of fecal occult blood tests. CONCLUSION:  For the first time, we report the implications of the continuity of care for DM2 patients in Saudi Arabia and the Middle East. Continuity of care did not result in the improvement of health indicators or in the completion of preventive health screenings in diabetic patients. Further studies are needed in the region to confirm our findings and assess the association between continuity of care and patient health indicators impact.