The effect of physician continuity on diabetic outcomes in a resident continuity clinic.
BACKGROUND
Conflicting data exists regarding the effect of continuity on diabetes care. Resident physicians frequently treat patients with diabetes in their continuity clinics; however, maintaining continuity in a resident clinic can be very challenging.


OBJECTIVE
To determine if resident continuity is associated with improvement in diabetic outcomes (HgA1c, LDL, blood pressure) in a resident clinic.


METHODS
Retrospective analysis of data obtained from a medical record review of diabetic patients seen in a resident physician clinic.


METHODS
We measured continuity, using the Usual Provider of Continuity Index (UPC) for residents and faculty preceptors. We measured changes in HgA1c, LDL, and blood pressure over a 3-year period. Using repeated measures analysis of variance (ANOVA), we assessed the relationship between UPC and change in these diabetic outcomes.


RESULTS
The resident UPC was 0.43, and the faculty preceptor UPC was 0.76. The overall change in HgA1c was -0.3. There was a statistically significant relationship between improvement in HgA1c and resident UPC (p = 0.02), but not faculty preceptor UPC. There was no association between resident or faculty preceptor continuity and change in LDL or blood pressure.


CONCLUSIONS
This study showed a link between resident continuity and improvement in glycemic control in diabetic patients. Resident physicians have a greater opportunity to develop a personal relationship with their patients. This interpersonal continuity may be of benefit in patients with illnesses that requires a significant amount of self-management behaviors. Medical training programs should focus efforts on improving continuity in resident primary care clinics.
Dearinger
Angela T
AT
Department of General Internal Medicine, Division of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY, USA. angelatackett@uky.edu
Wilson
John F
JF
Griffith
Charles H
CH
Scutchfield
F Douglas
FD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care; D003479:Curriculum; D003920:Diabetes Mellitus / Q000628:therapy*; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D011787:Quality of Health Care