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BMC Primary Care
Published in: BMC Primary Care 1/2021

Open Access 01-12-2021 | Care | Research article

Effects of continuity of care on health outcomes among patients with diabetes mellitus and/or hypertension: a systematic review

Authors: Kam-Suen Chan, Eric Yuk-Fai Wan, Weng-Yee Chin, Will Ho-Gi Cheng, Margaret Kay Ho, Esther Yee-Tak Yu, Cindy Lo-Kuen Lam

Published in: BMC Primary Care | Issue 1/2021

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Abstract

Background

The rising prevalence of non-communicable diseases (NCDs) such as diabetes mellitus (DM) and hypertension (HT) has placed a tremendous burden on healthcare systems around the world, resulting in a call for more effective service delivery models. Better continuity of care (CoC) has been associated with improved health outcomes. This review examines the association between CoC and health outcomes in patients with DM and/or HT.

Methods

This was a systematic review with searches carried out on 13 March 2021 through PubMed, Embase, MEDLINE and CINAHL plus, clinical trials registry and bibliography reviews. Eligibility criteria were: published in English; from 2000 onwards; included adult DM and/or HT patients; examined CoC as their main intervention/exposure; and utilised quantifiable outcome measures (categorised into health indicators and service utilisation). The study quality was evaluated with Critical Appraisal Skills Programme (CASP) appraisal checklists.

Results

Initial searching yielded 21,090 results with 42 studies meeting the inclusion criteria. High CoC was associated with reduced hospitalisation (16 out of 18 studies), emergency room attendances (eight out of eight), mortality rate (six out of seven), disease-related complications (seven out of seven), and healthcare expenses (four out of four) but not with blood pressure (two out of 13), lipid profile (one out of six), body mass index (zero out of three). Six out of 12 studies on diabetic outcomes reported significant improvement in haemoglobin A1c by higher CoC. Variations in the classification of continuity of care and outcome definition were identified, making meta-analyses inappropriate. CASP evaluation rated most studies fair in quality, but found insufficient adjustment on confounders, selection bias and short follow-up period were common limitations of current literatures.

Conclusion

There is evidence of a strong association between higher continuity of care and reduced mortality rate, complication risks and health service utilisation among DM and/or HT patients but little to no improvement in various health indicators. Significant methodological heterogeneity in how CoC and patient outcomes are assessed limits the ability for meta-analysis of findings. Further studies comprising sufficient confounding adjustment and standardised definitions are needed to provide stronger evidence of the benefits of CoC on patients with DM and/or HT.
Appendix
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Metadata
Title
Effects of continuity of care on health outcomes among patients with diabetes mellitus and/or hypertension: a systematic review
Authors
Kam-Suen Chan
Eric Yuk-Fai Wan
Weng-Yee Chin
Will Ho-Gi Cheng
Margaret Kay Ho
Esther Yee-Tak Yu
Cindy Lo-Kuen Lam
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2021
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-021-01493-x

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