Continuity of Care and Health Care Utilisation by Patients with Multi-morbidity Attending Primary Care Centres Attached to a Medical College in South India: A Cross-sectional Study

Abstract

Background

The prevalence of multi-morbidity in India is found to be 45.26% among the urban poor. Continuity of care can improve health outcomes for patients with multi-morbidity. Yet, the health care delivery in India is fragmented. There is paucity of literature on continuity of care in India.

Methods

A cross-sectional study was done to measure continuity of care using Usual Provider of Care Index (UPCI) in patients with multi-morbidity. Data was collected from the urban health centre (UHC), community clinics (CCs) and the two family medicine centres (FMCs) in Vellore, South India. About 130-140 patients with two or more chronic diseases seen for a minimum of three visits over one year from UHC, CCs and the FMCs. The UPCI was calculated and scored from 0 to 1.

Results

Mean (standard deviation [SD]) frequency of consultations to the same physician was 2.8 (1.7) at the CCs; 2.0 (1.5) at the UHC and 3.4 (1.9) at the FMCs. Senior physicians were most frequently seen in all the three settings. The UPCI score was poor (0%-40%) in 71% at the UHC, average (41%-60%) in 42.8% at the CCs and good (> 60%) in 65.9% at the FMC. At the UHC, those with consultations of five or less over one year (X² = 18.22, odds ratio [OR] = 0.18, 95% confidence interval [CI] = 0.08-0.41), consultation with a senior physician (X² = 4.40, OR = 0.33, 95% CI = 0.11-0.96) and on ≤ five medicines (X² = 7.54, OR = 0.34, 95% CI = 0.16-0.75) had significantly higher UPCI score of ≥ 50%.

Conclusions

High continuity with senior physicians and smaller practices with regular availability of physicians was associated with higher odds of less no of consultations and medicines.