Does having a personal physician improve quality of care in diabetes?

Abstract

Purpose: Although having a continuous relationship with a physician is a defining feature of primary care, few studies have evaluated the effect of this on chronic disease management. This aim of this study was to examine whether having a regular physician is associated with improvements in reaching treatment goals for patients with diabetes. Methods: Through the use of a diabetes registry, patients diagnosed with diabetes mellitus for a minimum of 6 months cared for in a large, single academic family medicine practice were compared based on whether they had a regular physician or not. The 2 groups were compared in the frequency in which they achieved goals for management of glycated hemoglobin, blood pressure, low-density lipoprotein cholesterol, and other aspects of diabetes care. Results: Patients with a regular provider were slightly older than those without a provider (57.5 years vs. 50.9 years; P = .002), but the gender distribution and percent who were smokers was the same. In assessing diabetes quality measures, patients with a regular provider had lower average levels of glycated hemoglobin (7.70 vs 8.53; P = .01), but no difference was noted in the percentage achieving a goal of ≤7.0. No differences were noted between the groups in either the average systolic or diastolic blood pressures or low-density lipoprotein cholesterol or in the percentages of patients achieving recognized goals for these measures. When examining other preventive services, patients with a regular provider were more likely to receive an influenza immunization within the last year (51.8% vs 35.6%; P = .02) but no more likely to receive a pneumococcal vaccine or take an aspirin each day. Conclusion: This study suggests that there are few benefits for patients with diabetes in having an established regular provider over having a regular place of service.