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. DESIGN AND SETTING  Retrospective analysis of data obtained from a medical record review of diabetic patients seen in a resident physician clinic. MEASUREMENTS  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. CONCLUSION  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.