Continuity in diabetes care

The terms compliance, adherence, concordance, and persistence, all indicate different aspects of a person′s relationship with his or her prescribed therapy. All these concepts have been discussed in detail, and their pros and cons debated earlier.[1] Irrespective of their different connotations, they all portray a drug-centered picture of treatment. Though important in their own right, these words totally ignore other, equally relevant, aspects of chronic health care, such as the patient - provider relationship. The phrase "therapeutic alliance" tries to encompass this facet of management,[2] but does not succeed fully.

Diabetes care is a multifaceted, long lasting, bidirectional relationship between a person with diabetes and his or her health care provider. This relationship involves much more than a single prescription. Its addresses, and is influenced by, various biological, psychological, social, and environmental factors.[3]

We hereby propose a new term, "continuity", which can be used in chronic disease management in general, and diabetes care in specific. Continuity can be defined as a state in which the person with diabetes continues to seek care from a particular health care provider, or a health care organization. A discontinuity implies a break in this relationship, with the person in diabetes choosing to, or being compelled to, stops taking care from his or her provider or organization. Discontinuity may be absolute or partial, and temporary or indefinite. Absolute discontinuity implies complete cessation of a professional relationship with the provider or organization. Partial discontinuity connotes that for certain but not all, services, whether diagnostic or therapeutic, the person with diabetes has changed his or her provider.

As we try to enhance the quality of diabetes care in various ways, we need to focus on the concept of continuity. Diabetes care professionals should aim to expand continuity, while focusing on the reason which can cause a discontinuity.

• References

• 1 Lutfey KE, Wishner WJ. Beyond “compliance” is “adherence”. Improving the prospect of diabetes care. Diabetes Care 1999; 22: 635-639
• 2 Reach G. Observance in diabetes: From therapeutic education to therapeutic alliance. Ann Med Interne (Paris) 2003; 154: 117-120
• 3 Kalra S, Balhara YS, Das AK. The bio-psycho-social model and the American Diabetes Association European Association for the Study of Diabetes position statement on management of hyperglycemia. J Soc Health Diabetes 2013; 1: 53-55
• 4 Ascher-Svanum H, Lage MJ, Perez-Nieves M, Reaney MD, Lorraine J, Rodriguez A. et al. Early discontinuation and restart of insulin in the treatment of type 2 diabetes mellitus. Diabetes Ther 2014; 5: 225-242
• 5 Chinenye S, Ogbera AO, Kalra S. Patient-centered care in diabetology: Sub-Saharan African perspectives. Afr J Diabetes Med 2014; 22: 5-8