title: Effect of continuity of care on health-related quality of life in adult patients with hypertension: a cohort study in China.
abstract: Continuity of care is widely considered a principle of primary care that decreases healthcare utilization and mortality. However, the effect of continuity of care on health-related quality of life (HRQoL) for adult patients with hypertension remains unclear.
  
  
  
  To further evaluate the effect of continuity of care, we implemented a cohort study among hypertensive patients aged over 35 years (n = 1200) in six townships in Qianjiang District, Chongqing, China, between 2012 and 2014. The study ultimately included 1079 participants. The continuity of care index was calculated using claim-based longitudinal data obtained from hypertension follow-up service records. The baseline and endline survey-based data, tested by the SF-36 scale, were used to assess HRQoL. To control selection bias and examine the effect of continuity of care, a kernel-based propensity score matching difference-in-differences (DID) method was used. Additionally, descriptive statistics, chi-squared test, and Mann-Whitney nonparametric test were used to summarize characteristics, evaluate proportional differences, and analyze statistical differences, respectively.
  
  
  
  Our results showed that patients in the high continuity of care group presented greater improvement in both Physical Component Summary (PCS, DID = 5.192 ± 1.970, p < 0.001) and Mental Component Summary (MCS, DID = 7.900 ± 1.815, p = 0.008) than those in the low continuity of care group. Moreover, patients in the high continuity of care group showed significant improvement in physical functioning, role-physical, general health, role-emotional, and mental health.
  
  
  
  Our findings indicate that a long-term physician-patient relationship may improve HRQoL in patients with hypertension. However, more unified measurement tools are needed to evaluate continuity of care. Further studies should include more study settings.
authors.affiliation: School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, China.
authors.forename: Ting
authors.initials: T
authors.lastname: Ye
authors.affiliation: School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, China.
authors.forename: Xiaowei
authors.initials: X
authors.lastname: Sun
authors.affiliation: School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China.
authors.forename: Wenxi
authors.initials: W
authors.lastname: Tang
authors.affiliation: School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, China.
authors.forename: Yudong
authors.initials: Y
authors.lastname: Miao
authors.affiliation: School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, China. zhangliang@mails.tjmu.edu.cn.
authors.forename: Liang
authors.initials: L
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002681:China; D015331:Cohort Studies; D003266:Continuity of Patient Care; D005260:Female; D006304:Health Status; D006801:Humans; D006973:Hypertension / Q000523:psychology / Q000628:therapy*; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010817:Physician-Patient Relations; D011788:Quality of Life; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires
keywords: China; Cohort study; Continuity of care; Health-related quality of life; Hypertension