J Korean Med Sci.  2017 Dec;32(12):1921-1930. 10.3346/jkms.2017.32.12.1921.

Emergency Department Visits Can Be Reduced by Having a Regular Doctor for Adults with Diabetes Mellitus: Secondary Analysis of 2013 Korea Health Panel Data

Affiliations
  • 1Department of Family Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea. jaeholee@catholic.ac.kr
  • 2Department of Family Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea.
  • 3Department of Family Medicine, Jeongeup Asan Hospital, Jeongeup, Korea.

Abstract

Chronic diseases pose a major challenge to population health worldwide. Diabetes is a major chronic disease that is managed overwhelmingly in primary care. There is an increasing recognition of the role that primary care physicians play to achieve high-quality care for patients with diabetes. By analyzing 2013 Korean Health Panel data, the authors aimed to determine the current status of having a regular doctor (RD) for adults (aged 18 years or older) with diabetes. In addition, the association of having a RD with the experience of emergency department (ED) visits was determined in this study. Among adults with diabetes, those with RD accounted for 41.0%. The older the age group and the higher the Charlson comorbidity index score, the higher the percentage of adults with diabetes had RD. Even for those with RD, coordination of care was very poor (positive answer: 27.1%). After adjustment for confounding variables, those having (vs. not having) a RD (odds ratio [OR], 0.57; 95% confidence interval [CI], 0.35-0.94), especially those whose RDs delivered good comprehensiveness of care (OR, 0.47; 95% CI, 0.26-0.84) or worked at a primary care clinic (OR, 0.43; 95% CI, 0.22-0.81), and those whose longitudinal relationship with a RD was 5 years or less (OR, 0.45; 95% CI, 0.22-0.91) were less likely to have ED visits within the last year. In conclusion, health care policies that promote having a RD who delivers high-quality primary care could decrease unnecessary ED visits by diabetic adults. This can partly reduce ED overcrowding in Korea.

Keyword

Diabetes Mellitus; Primary Health Care; Health Policy; Emergency Department; Korea

MeSH Terms

Adult*
Chronic Disease
Comorbidity
Confounding Factors (Epidemiology)
Delivery of Health Care
Diabetes Mellitus*
Emergencies*
Emergency Service, Hospital*
Health Policy
Humans
Korea*
Physicians, Primary Care
Primary Health Care

Figure

  • Fig. 1 Sample selection process for analysis in this study.


Reference

1. World Health Organization. Global report on diabetes [Internet]. accessed on 3 July 2017. Available at http://www.who.int/diabetes/global-report/en/.
2. Carls G, Huynh J, Tuttle E, Yee J, Edelman SV. Achievement of glycated hemoglobin goals in the US remains unchanged through 2014. Diabetes Ther. 2017; 8:863–873.
3. Korean Diabetes Association. Diabetes fact sheet in Korea 2016 [Internet]. accessed on 3 July 2017. Available at http://www.diabetes.or.kr/pro/news/admin.php?category=A&code=admin&number=1428&mode=view.
4. Peterson KA, Radosevich DM, O’Connor PJ, Nyman JA, Prineas RJ, Smith SA, Arneson TJ, Corbett VA, Weinhandl JC, Lange CJ, et al. Improving diabetes care in practice: findings from the TRANSLATE trial. Diabetes Care. 2008; 31:2238–2243.
5. Mostashari F, Sanghavi D, McClellan M. Health reform and physician-led accountable care: the paradox of primary care physician leadership. JAMA. 2014; 311:1855–1856.
6. Kiran T, Glazier RH, Campitelli MA, Calzavara A, Stukel TA. Relation between primary care physician supply and diabetes care and outcomes: a cross-sectional study. CMAJ Open. 2016; 4:E80–E87.
7. Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005; 83:457–502.
8. Manns BJ, Tonelli M, Zhang J, Campbell DJ, Sargious P, Ayyalasomayajula B, Clement F, Johnson JA, Laupacis A, Lewanczuk R, et al. Enrolment in primary care networks: impact on outcomes and processes of care for patients with diabetes. CMAJ. 2012; 184:E144–E152.
9. Lee JH, Choi YJ, Volk RJ, Kim SY, Kim YS, Park HK, Jeon TH, Hong SK, Spann SJ. Defining the concept of primary care in South Korea using a Delphi method. Fam Med. 2007; 39:425–431.
10. Starfield B. Primary Care: Balancing Health Needs, Services, and Technology. New York, NY: Oxford University Press;1998.
11. Ionescu-Ittu R, McCusker J, Ciampi A, Vadeboncoeur AM, Roberge D, Larouche D, Verdon J, Pineault R. Continuity of primary care and emergency department utilization among elderly people. CMAJ. 2007; 177:1362–1368.
12. Tiagi R, Chechulin Y. The effect of rostering with a patient enrolment model on emergency department utilization. Healthc Policy. 2014; 9:105–121.
13. Brown AD, Goldacre MJ, Hicks N, Rourke JT, McMurtry RY, Brown JD, Anderson GM. Hospitalization for ambulatory care-sensitive conditions: a method for comparative access and quality studies using routinely collected statistics. Can J Public Health. 2001; 92:155–159.
14. Tsai AC, Morton SC, Mangione CM, Keeler EB. A meta-analysis of interventions to improve care for chronic illnesses. Am J Manag Care. 2005; 11:478–488.
15. McCusker J, Roberge D, Lévesque JF, Ciampi A, Vadeboncoeur A, Larouche D, Sanche S. Emergency department visits and primary care among adults with chronic conditions. Med Care. 2010; 48:972–980.
16. Hussey PS, Schneider EC, Rudin RS, Fox DS, Lai J, Pollack CE. Continuity and the costs of care for chronic disease. JAMA Intern Med. 2014; 174:742–748.
17. Hong JS, Kang HC, Kim J. Continuity of care for elderly patients with diabetes mellitus, hypertension, asthma, and chronic obstructive pulmonary disease in Korea. J Korean Med Sci. 2010; 25:1259–1271.
18. Horwitz DA, Schwarz ES, Scott MG, Lewis LM. Emergency department patients with diabetes have better glycemic control when they have identifiable primary care providers. Acad Emerg Med. 2012; 19:650–655.
19. Hearld LR, Alexander JA. Patient-centered care and emergency department utilization: a path analysis of the mediating effects of care coordination and delays in care. Med Care Res Rev. 2012; 69:560–580.
20. Stern Z, Calderon-Margalit R, Mazar M, Brezis M, Tirosh A. Emergency room visit: a red-flag indicator for poor diabetes care. Diabet Med. 2009; 26:1105–1111.
21. Grumbach K, Keane D, Bindman A. Primary care and public emergency department overcrowding. Am J Public Health. 1993; 83:372–378.
22. Chai YS, Lee JK, Park SS, Kim HJ, Kang IG, Kim HS, Lee MS, Hong JY, Lee MJ. Use of emergency medical services and characteristics of urgent and non-urgent adult patients according to the usual source of care: a Korea Medical Expenditure Panel Study. J Korean Soc Emerg Med. 2015; 26:129–137.
23. An AR, Kim K, Lee JH, Sung NJ, Lee SI, Hyun MK. Having a usual source of care and its associated factors in Korean adults: a cross-sectional study of the 2012 Korea Health Panel Survey. BMC Fam Pract. 2016; 17:167.
24. Korea Health Panel. About Korea health panel [Internet]. accessed on 21 June 2017. Available at https://www.khp.re.kr:444/english/about_01.jsp.
25. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987; 40:373–383.
26. Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992; 45:613–619.
27. Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi JC, Saunders LD, Beck CA, Feasby TE, Ghali WA. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005; 43:1130–1139.
28. Jung KW, Won YJ, Kong HJ, Oh CM, Shin A, Lee JS. Survival of Korean adult cancer patients by stage at diagnosis, 2006–2010: national cancer registry study. Cancer Res Treat. 2013; 45:162–171.
29. Kim KM, Jeon H, Lee JH. Having a physician rather than a place as a usual source of care would be better — from 2012 Korea Health Panel data. J Korean Med Sci. 2017; 32:4–12.
30. Schoen C, Osborn R, Doty MM, Bishop M, Peugh J, Murukutla N. Toward higher-performance health systems: adults’ health care experiences in seven countries, 2007. Health Aff (Millwood). 2007; 26:w717–w734.
31. Organisation for Economic Co-operation and Development. OECD reviews of health care quality: Korea 2012—raising standards [Internet]. accessed on 3 July 2017. Available at http://dx.doi.org/10.1787/9789264173446-en.
32. Mossialos E, Djordjevic A, Osborn R, Sarnak D. International Pofiles of Health Care Systems. New York, NY: The Commonwealth Fund;2017.
33. Organisation for Economic Co-operation and Development. OECD health care quality review: Korea—assessment and recommendations [Internet]. accessed on 2 July 2017. Available at http://www.oecd.org/korea/49818570.pdf.
34. Pourat N, Davis AC, Chen X, Vrungos S, Kominski GF. In California, primary care continuity was associated with reduced emergency department use and fewer hospitalizations. Health Aff (Millwood). 2015; 34:1113–1120.
35. Haggerty JL, Roberge D, Pineault R, Larouche D, Touati N. Features of primary healthcare clinics associated with patients’ utilization of emergency rooms: urban-rural differences. Healthc Policy. 2007; 3:72–85.
36. McCusker J, Tousignant P, Borgès Da Silva R, Ciampi A, Lévesque JF, Vadeboncoeur A, Sanche S. Factors predicting patient use of the emergency department: a retrospective cohort study. CMAJ. 2012; 184:E307–E316.
37. Carter R, Quesnel-Vallée A, Plante C, Gamache P, Lévesque JF. Effect of family medicine groups on visits to the emergency department among diabetic patients in Quebec between 2000 and 2011: a population-based segmented regression analysis. BMC Fam Pract. 2016; 17:23.
38. Wu S, Wang R, Zhao Y, Ma X, Wu M, Yan X, He J. The relationship between self-rated health and objective health status: a population-based study. BMC Public Health. 2013; 13:320.
39. Goldman N, Lin IF, Weinstein M, Lin YH. Evaluating the quality of self-reports of hypertension and diabetes. J Clin Epidemiol. 2003; 56:148–154.
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