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Richelle J. Koopman, MD; Arch G. Mainous III, PhD; Richard Baker, MD; James M. Gill, MD, MPH; Gregory E. Gilbert, MSPH

Arch Intern Med. 2003;163:1357-1361.

Background  Continuity of care has been shown to have a variety of health benefits, but the effect of continuity of care on recognition of common chronic diseases has been underinvestigated.

Objective  To examine the relationship between continuity of care and the recognition of 3 prevalent chronic diseases: diabetes, hypertension, and hypercholesterolemia.

Methods  We analyzed data from the third National Health and Nutrition Examination Survey, a nationally representative sample of 18 162 adult noninstitutionalized residents of the United States collected from 1988 through 1994. We examined the proportion of unrecognized disease among all individuals with diabetes, hypertension, and hypercholesterolemia according to self-reported level of continuity of care. We used logistic regression to control for possible confounders, including number of disease risk factors.

Results  Among persons with diabetes, in adjusted models, those with a usual provider of care had a lower likelihood of having unrecognized disease (odds ratio, 0.30; 95% confidence interval, 0.10-0.95) than those with no usual site or provider of care. Unrecognized hypertension had an unadjusted relationship with level of continuity of care, but continuity of care was not a significant predictor after possible confounders were adjusted for. Unrecognized hypercholesterolemia was not predicted by level of continuity of care.

Conclusions  Continuity of care has some benefits in terms of recognizing chronic disease, although benefits appear to be disease specific. More research needs to be conducted to elucidate the complex relationship between continuity and disease recognition.

From the Department of Family Medicine, Medical University of South Carolina, Charleston (Drs Koopman and Mainous and Mr Gilbert); the Department of General Practice and Primary Health Care, University of Leicester, Leicester, England (Dr Baker); and the Department of Family and Community Medicine, Christiana Care Health Services, Wilmington, Del (Dr Gill). The authors have no relevant financial interest in this article.

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