Re: Does Having a Personal Physician Improve Quality of Care in Diabetes?

To the Editor: We have read with interest the article by Hueston,¹ “Does having a personal physician improve quality of care in diabetes?” in your January/February issue, but we have serious reservations about his conclusion for several reasons.

First, although he cites 4 articles coauthored by Arch Mainous, he omits the one by Mainous most directly relevant to this article, which was Mainous and Gill (1998),² showing that for patients the benefits of continuity of care flow more from a personal relationship than from seeing others at the same site of care.

Secondly, he examined the records of some people who had had diabetes for only 6 months, and only 2 consultations, which is much too short a period and too few contacts for effects of continuity of care mediated through a regular provider to be fairly measured.

Thirdly, he diminishes the work of O’Connor and colleagues (1998)³ who, with a much bigger population studied, found a whole series of benefits for patients from having a regular provider. These included having better glycaemic control and receiving most recommended elements of modern disease management. His reference to those showing value in continuity as revealing some (our emphasis) benefits is inaccurate, as O’Connor and colleagues showed many important benefits.

Fourthly, having correctly reported that several studies have shown that continuity of care in family practice is associated with increased satisfaction by patients (to which we would add others^4,5), he then ignores this very important outcome in his conclusion. There is also important evidence from Canada that continuity of care by family physicians is associated with a significantly lower rate of admissions to hospital for the elderly.⁶

Finally, he showed no disadvantages of continuity of care via a regular provider and did find 2 advantages, one of which, a significantly lower HbA1C, is the cardinal measure of diabetes control. His conclusion that there are “few benefits” of having a regular provider does not follow from his own findings.