Continuity of Care, Medication Adherence, and Health Care Outcomes Among Patients With Newly Diagnosed Type 2 Diabetes: A Longitudinal Analysis
BACKGROUND:: The effects of continuity of care (COC) on health care outcomes are well established. However, the mechanism of this association is not fully understood. OBJECTIVE:: The objective of this study was to examine the relationship between COC and medication adherence, as well as to investigate the mediating effect of medication adherence on the association between COC and health care outcomes, in patients with newly diagnosed type 2 diabetes. RESEARCH DESIGN AND SUBJECTS:: This study utilized a longitudinal design and included a 7-year follow-up period from 2002 to 2009 under a universal health insurance program in Taiwan. Patients aged 18 years or older who were first diagnosed with type 2 diabetes in 2002 were included in the study. Random intercept models were conducted to assess the temporal relationship between COC, medication adherence, and health care outcomes. RESULTS:: Patients with high or intermediate COC scores were more likely to be adherent to medications than those with low COC scores [odds ratio (OR), 3.37; 95% confidence interval (CI), 3.15-3.60 and OR, 1.84; 95% CI, 1.74-1.94, respectively]. In addition, the association between COC and health care outcomes was partly mediated by better medication adherence in patients with newly diagnosed type 2 diabetes. CONCLUSIONS:: Improving the COC for patients with type 2 diabetes may result in higher medication adherence and better health care outcomes.
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