Impact of Comprehensive Primary Care in Patients With Complex Chronic Diseases: Nationwide Cohort Database Analysis in Korea

More comprehensive healthcare services should be provided to patients with complex chronic diseases to better manage their complex care needs. This study examined the effectiveness of comprehensive primary care in patients with complex chronic diseases. We obtained 2002-2019 data from the National H...

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Bibliographic Details
Published in:	Journal of Korean medical science Vol. 39; no. 18; p. e158
Main Authors:	Hur, Ryun, Kim, Kyoung-Hoon, Jin, Dal-Lae, Yoon, Seok-Jun
Format:	Journal Article
Language:	English
Published:	Korea (South) The Korean Academy of Medical Sciences 13-05-2024 대한의학회
Subjects:	Adult Aged Cardiovascular Diseases - epidemiology Cardiovascular Diseases - therapy Cerebrovascular Disorders - epidemiology Chronic Disease Cohort Studies Comprehensive Health Care Databases, Factual Diabetes Mellitus - epidemiology Female Hospitalization Humans Hyperlipidemias - epidemiology Hypertension - epidemiology Male Middle Aged Original Primary Health Care Proportional Hazards Models Republic of Korea - epidemiology 의학일반 Republic of Korea Hospital Admission National Health Insurance Sampled Cohort Database Primary Care Comprehensiveness Retrospective Cohort Study
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Summary:	More comprehensive healthcare services should be provided to patients with complex chronic diseases to better manage their complex care needs. This study examined the effectiveness of comprehensive primary care in patients with complex chronic diseases. We obtained 2002-2019 data from the National Health Insurance Sample Cohort Database. Participants were individuals aged ≥ 30 years with at least two of the following diseases: hypertension, diabetes mellitus, and hyperlipidemia. Doctors' offices were classified into specialized, functional, and gray-zone based on patient composition and major diagnostic categories. The Cox proportional hazard model was used to examine the association between office type and hospital admission due to all-causes, severe cardiovascular or cerebrovascular diseases (CVDs), hypertension, diabetes mellitus, or hyperlipidemia. The mean patient age was 60.3 years; 55.8% were females. Among the 24,906 patients, 12.8%, 38.3%, and 49.0% visited specialized, functional, and gray-zone offices, respectively. Patients visiting functional offices had a lower risk of all-cause admission (hazard ratio [HR], 0.935; 95% confidence interval [CI], 0.895-0.976) and CVD-related admission (HR, 0.908; 95% CI, 0.844-0.977) than those visiting specialized offices. However, the admission risks for hypertension, diabetes mellitus, and hyperlipidemia were not significantly different among office types. This study provides evidence of the effectiveness of primary care in functional doctors' offices for patients with complex chronic diseases beyond a single chronic disease and suggests the need for policies to strengthen functional offices providing comprehensive care.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Ryun Hur and Kyoung-Hoon Kim contributed equally to this work.
ISSN:	1011-8934 1598-6357
DOI:	10.3346/jkms.2024.39.e158