Introduction

Due to rapid population aging, Korea became a super-aged society at the end of 2024, as the proportion of the population aged 65 or older exceeded 20% of the total population, and the number of people aged 65 or older is projected to comprise more than 30% of the total population by 2036 [1]. These changes in the structure of the population are leading to an increase in the prevalence of multimorbidity, which is a key factor contributing to rising healthcare expenditure [2]. It is reported that 82.2% of the elderly aged 65 years or older have at least one chronic disease, 60% are multimorbid patients with two or more chronic diseases, and 35.9% are multimorbid patients with three or more chronic diseases [3,4]. In particular, hypertension and diabetes are the most common chronic diseases among adults in Korea, and their prevalence rates are approximately 28% and 15%, respectively. These two diseases are the main causes of severe complications such as cardiovascular diseases, and they also act as underlying diseases that increase the complexity of treatment as well as health risks through interactions with other chronic diseases [5-7]. Therefore, effective management of hypertension and diabetes, through lifestyle modification, medication therapy, and continuous and consistent integrated health management, is essential for suppressing the progression of multimorbidity, maintaining quality of life, and reducing the burden of medical expenses [8].

In many countries, primary care delivered by medical professionals has been utilized as a key strategy for continuous and consistent chronic disease management, but this system has not been properly established in Korea’s healthcare environment [9,10]. In the absence of the primary care system in Korea, several studies have attempted to investigate the pattern of repeated uses of healthcare services through the concept of usual source of care. A usual source of care (USoC) is defined as a specific clinic, hospital, or public health center that an individual usually goes to when he or she is sick or in need of medical advice [11], and it is currently attracting attention as a point that reflects a patient’s continuous relationship with medical professionals and environment. USoC was found to be associated with improvements in various health indicators, including reduced medical expenses and inpatient costs [12] and decreased prevalence of depression [13].

USoC should not only serve as a patient’s first point of contact for healthcare services, but also provide continuous and comprehensive healthcare services and care coordination, and thus positively influence patients’ healthcare utilization patterns and health outcomes [14]. Among the functions of USoC, care coordination is defined as a process in which patients, family members, and healthcare workers share information, systematically coordinate activities, and efficiently allocate and deploy personnel and resources to support the consistent and effective organization of treatment processes [15,16]. It also plays a key role in the management of chronic diseases, alongside medication therapy and lifestyle modification [17]. In 2019, the World Health Organization (WHO) recommended an integrated approach based on the principle of ‘Integrated Care for Older People (ICOPE)’, emphasizing the integrated provision of community-based health and social care services, linkage with community resources, and collaboration among community resources [18]. In addition, care coordination has important implications in the context of Korea’s significant policy shift toward integrated community care, which is scheduled to be fully implemented in March 2026.

The importance and necessity of care coordination in chronic disease management have already been widely recognized and actively studied. First, previous studies have established the concept of care coordination and emphasized the importance of this function [19,20]. In addition, the majority of prior studies on care coordination have been mainly focused on verifying its effectiveness by setting care coordination as an independent variable. A study conducted with diabetic patients in Korea reported that only 27.1% of diabetic patients positively evaluated care coordination, and that care coordination did not significantly reduce experiences of visiting an emergency department [21]. However, one study found that an intervention including care coordination not only improved patients’ quality of life but also was highly cost-effective [8]. As awareness of the importance and necessity of care coordination has expanded and in line with the growing momentum of integrated community care systems, studies have been conducted in Korea to strengthen nurses’ care coordination competencies [22] and to identify the practical challenges faced by healthcare professionals regarding care coordination [23]. However, insufficient research has been conducted to consider the characteristics of patients receiving care coordination and to systematically explore the factors that influence care coordination. 42% of elderly patients reported that care coordination among healthcare providers was not properly carried out [24]. Also, socioeconomic vulnerability, presence of chronic disease, presence of caregivers, and a high burden of disease have been found to be significantly associated with the provision of care coordination [24,25]. In addition, external environmental factors such as geographical accessibility have also been reported to be factors in care coordination [26]. However, to date, no quantitative study in Korea has examined the factors influencing care coordination.

Given that USoC plays a key facilitating role in care coordination, it is important to conduct empirical research that examines how the attributes of USoC and the personal characteristics of patients with chronic conditions are related to care coordination. To address this research gap, this study aimed to analyze the factors affecting the provision of care coordination for patients with hypertension or diabetes using the Behavioral Model proposed by Ronald M. Andersen [27]. This theoretical framework, also known as Andersen’s Healthcare Utilization Model, helps to explain and predict why individuals use healthcare services and how various conditions and factors influence their decisions regarding healthcare utilization. In this study, the primary agents providing care coordination, which is the focal variable, are healthcare professionals, and this differs from Andersen’s model, which emphasizes the explanation of individual healthcare utilization. However, healthcare utilization is an interactive process that cannot occur without the services provided by healthcare professionals; it involves not merely the patient’s act of receiving healthcare but also the process through which healthcare professionals deliver appropriate services in response to patients’ health needs. Therefore, care coordination by healthcare professionals can be regarded as an essential and active component of healthcare utilization, and it may be interpreted as a process that reflects the qualitative aspect of utilization, given that it is realized through interactions between patients and healthcare professionals.

This study aims to analyze the level of care coordination and its influencing factors among patients with hypertension or diabetes with USoC, using Andersen’s Behavioral Model as the theoretical framework. Variables were selected and classified according to the three factors proposed in the model (predisposing, enabling, and need factors). In particular, the study seeks to comprehensively explore the structural context of care coordination by including not only patient-side factors, such as the sociodemographic characteristics of patients, but also provider-side factors, such as the specialty of the USoC physician and the type of USoC institution. The specific objectives of this study are:

(1) To examine the characteristics of patients with hypertension or diabetes and assess their level of care coordination;

(2) To identify factors influencing care coordination in these patients.

Methods

Study design

This study is a descriptive, cross-sectional study to systematically explore various factors influencing care coordination among patients with hypertension or diabetes who have USoC, based on Andersen’s Behavioral Model by using the data from Korea Health Panel Survey (KHPS), a national database jointly developed by the Korea Institute for Health and Social Affairs and the National Health Insurance Service. The conceptual framework of this study is presented in Figure 1.

Study population

KHPS data is a panel data built through a comprehensive survey of the medical service usage, medical expenses, and related factors of individuals and households to improve the national healthcare system. The second panel data, which began in 2019, has been collected annually by selecting the participants nationwide by a stratified multi-stage probability sampling method based on region and residence. Using the 2021 KHPS data, 4,233 adults, aged 19 years or older, diagnosed with hypertension or diabetes, were extracted from a total of 13,799 participants. Then, 2,589 people who had a usual source of care and responded to a question about care coordination were selected as the study participants. After excluding 13 people with missing data, a total of 2,576 people were included in the final analysis (Figure 2).

Measures

Dependent variable

In this study, care coordination was operationally defined based on the following question used in the 2021 Korea Health Panel Survey: “Does your USoC doctor appropriately give you a guide to healthcare facilities or professionals necessary for health management (e.g., specific specialists, medical institutions, social welfare centers, long-term care facilities, caregivers, a smoking cessation helpline, etc.)?” Responses to this question were collected on a five-point Likert scale. Participants who answered “almost always” or “mostly yes” were classified as having received care coordination, while those who answered “neutral,” “mostly no,” or “almost never” were classified as not having received care coordination.

Independent variables

This study comprehensively reviewed the survey items of the Korea Health Panel Survey in conjunction with Andersen’s Behavioral Model to identify the factors influencing care coordination among patients with hypertension or diabetes who have a usual source of care. Based on this review, variables corresponding to the model were extracted and classified as independent variables into predisposing, enabling, and need factors [28].

Predisposing factors

Predisposing factors are basic characteristics that predict the use of healthcare services; although they do not directly cause utilization, they exert indirect effects in combination with other elements [29]. In this study, age, sex, education level, marital status, employment status, smoking status, alcohol consumption, and physical activity were classified as predisposing factors. Specifically, age was divided into four age groups: ‘under 40’, ‘40 to 59’, ‘60 to 79’, and ‘80 and over.’ Sex was categorized into male and female. Education level was classified into ‘elementary school or lower’, ‘middle school’, ‘high school’, and ‘college or higher’, and marital status was categorized into ‘married’, ‘not married’, and ‘divorced or widowed.’ As for employment status, ‘employed wage worker’, ‘employer’, and ‘self-employed’ were categorized as ‘employed’, and ‘the economically inactive’ as ‘unemployed.’ For smoking status, ‘daily smoker’ and ‘occasional smoker’ were categorized as ‘smokers’, and ‘never smoked’ and ‘former smoker’ as ‘non-smokers.’ Alcohol consumption was categorized into ‘high-risk drinking’, ‘low-risk drinking’, and ‘non-drinking’, based on the frequency of alcohol consumption in the past year with the criteria for high-risk drinking [30]. Physical activity was categorized as ‘Yes’ or ‘No’ based on whether they had engaged in regular exercise during the past year.

Enabling factors

Enabling factors include individual, family, and community resources, and also include external and environmental factors necessary for access to health care services [29]. These resources can facilitate or restrict access to health care services, depending on their availability and distribution. In this study, household income level, health insurance type, residential area, type of USoC, and USoC physician’s specialty were selected as enabling factors. Household income level was divided into five income groups based on the classification criteria of the 2020 household income quintiles of Statistics Korea, and health insurance type was divided into ‘National Health Insurance (NHI)’ and ‘Medicaid recipients.’ Residential area was classified into ‘urban’ and ‘rural.’ USoC type was classified into ‘local clinic’, ‘(tertiary) hospital’, ‘public health center’, ‘Korean medicine clinic or hospital’, and USoC physician’s specialty was classified into ‘family medicine’, ‘internal medicine’, ‘general practitioner’, ‘Korean medicine’, ‘other’, and ‘do not know.’

Need factors

Need factors are the most direct causes of healthcare service utilization and are based on an individual’s experience of illness and health status [29]. The need factors analyzed in this study were the number of chronic diseases without hypertension and diabetes, self-rated health status, and presence of disability. The number of chronic diseases was divided into ‘0’, ‘1’, and ‘2 or more’ based on the number of chronic diseases other than hypertension and diabetes. Self-rated health status was classified into ‘good’, ‘moderate’, and ‘poor’ by categorizing ‘very good’ and ‘good’ as ‘good’, and ‘poor’ and ‘very poor’ as ‘poor’. Finally, presence of disability was categorized into ‘Yes’ and ‘No’.

Data analysis

All statistical analyses were conducted with consideration of the complex sample design. The Korea Health Panel Survey employed the Population and Housing Census data as the sampling frame and used a two-stage stratified cluster sampling design with probability proportional to size (PPS) to ensure national representativeness. Therefore, to obtain unbiased estimates, data analysis must reflect all the relevant information of the sample design. For this purpose, the variables ‘REGION1’ and ‘REGION2’ provided by the Korea Health Panel Survey were used as stratification variables, and sampling weights were applied. In addition, responses from participants who did not meet the study inclusion criteria were not simply excluded; instead, subpopulations were specified for data analysis [31]. Through this approach, the analyses were conducted to ensure that the sample was as representative of the target population as possible.

First, descriptive statistics were performed to examine the characteristics and distributions of participants’ background and contextual factors. Unweighted frequencies were presented, while percentages were presented with weights applied. Next, to test differences in the provision of care coordination according to predisposing, enabling, and need factors, the Rao–Scott chi-square test(for complex survey data) was conducted. Finally, complex sample logistic regression analysis was performed to explore which factors influence care coordination among patients with hypertension or diabetes who have USoC. All statistical analyses were conducted using R (version 4.4.2), and the significance level was set at p<0.05.

Ethical considerations

This study was conducted after receiving an exemption determination from the Institutional Review Board (IRB) of Seoul National University (IRB No. E2501/003-003). The researcher completed an official application procedure for access to the KHPS data, and obtained approval for the use of data. After receiving the approval, the raw dataset, related questionnaires, and a codebook for the 2021 KHPS data were obtained and used for analysis. The research data were provided after anonymizing personal data by using unique identification numbers to protect personal information in compliance with the principles of research ethics.

Results

Characteristics of the participants and current status of care coordination

The characteristics of the study participants and the current status of care coordination are presented in Table 1. Regarding the predisposing factors of the study participants, the largest proportion was in the 60-79 age group (54.0%), followed by those aged 40-59 (30.3%) and those aged 80 or older (13.9%). In terms of sex distribution, women accounted for a slightly higher proportion than men (51.3% vs. 48.7%). With respect to educational level, high school (33.8%) and elementary school or less (27.6%) comprised the largest groups. For marital status, 66.4% were married, while 29.0% were divorced or widowed. More participants were economically active than inactive (59.3% vs. 40.7%). Non-smokers (84.0%) outnumbered smokers (16.0%). In terms of alcohol consumption, 19.2% were classified as high-risk drinkers, while the remaining participants (low-risk drinkers and non-drinkers) accounted for 80.8%. Finally, a slightly higher proportion of participants reported engaging in regular physical activity compared to those who did not (54.0% vs. 46.0%).

With respect to enabling factors, the middle-income group accounted for the largest proportion (33.5%), followed by the low-income group (26.9%) and the high-income group (20.6%). The majority were covered by national health insurance (93.7%). Urban residents (78.2%) outnumbered rural residents (21.8%). In terms of the USoC type, local clinics accounted for the highest proportion (68.3%), followed by (tertiary) hospitals (30.6%). Internal medicine as the specialty of the USoC had the highest proportion (74.2%), followed by family medicine (12.3%) and general practitioners (3.2%).

Regarding need factors, 55.9% of the total participants had no chronic diseases other than hypertension and diabetes, 28.4% had one additional chronic disease, and 15.7% had two or more additional chronic diseases. Although not presented in Table 1, among the major chronic diseases that the participants had in addition to hypertension or diabetes, musculoskeletal diseases (in the order of knees, spine, and shoulders) took up the largest proportion, followed by depression/bipolar disorder and asthma. The respondents who self-rated their health status as ‘moderate’ took up the largest proportion (48.9%), followed by those with ‘poor’ (29.0%) and ‘good’ (22.1%). 10.3% of participants reported having a disability.

Care coordination, the variable of interest in this study, was not provided to more than half of the respondents (55.3%).

Differences in care coordination by participant characteristics

The analysis of differences in care coordination by participant characteristics (Table 1) revealed significant differences in predisposing factors, specifically sex and employment status (sex: χ²=3.91, p=.048; employment status: χ²=8.28, p=.004). Among enabling factors, a significant difference was found in the specialty of the USoC physician (χ²=3.36, p=.006).

Analysis of influencing factors for care coordination

The test for multicollinearity showed that tolerance values ranged from 0.68 to 0.90, all above the threshold of 0.1, and the variance inflation factor (VIF) ranged from 1.11 to 1.60, all below 10. These results confirmed that there was no problem of multicollinearity among the independent variables.

The results of analyzing the factors affecting care coordination are shown in Table 2. Among predisposing characteristics, sex, employment status, and physical activity were found to be significant influencing factors for care coordination. First, the likelihood of receiving care coordination was 0.67 times lower among women than men (95% Confidence Interval, 95% CI=0.52-0.88, p=.004). Also, unemployed participants were 1.61 times more likely to receive care coordination than employed participants (95% CI=1.26-2.06, p<.001). In addition, participants who did not engage in regular physical activity were 1.3 times more likely to receive care coordination than those who engaged in regular physical activity (95% CI=1.04-1.62, p=.023). Among enabling factors, a significant difference was observed in the specialty of the USoC physician. Participants whose USoC physician was a general practitioner were 3.62 times more likely to receive care coordination compared to those whose USoC physician was a family medicine physician (95% CI=1.96-6.69, p<.001). Regarding need factors, a significant difference was found in the number of additional chronic conditions beyond hypertension and diabetes. People with two or more additional chronic diseases were found to be 1.42 times more likely to receive care coordination than those without additional chronic diseases (95% CI=1.03-1.95, p=.030).

Discussion

This study analyzed the current status of care coordination and its influencing factors among patients with hypertension or diabetes who have a USoC by using Andersen’s Behavioral Model as a theoretical framework. The results showed that more than half of the total respondents did not receive care coordination, and that care coordination was significantly associated with sex, employment status, regular physical activity, physician’s specialty, and number of chronic diseases. These findings are significant in that they empirically confirm the multilayered structure and determinative mechanisms of care coordination among patients with chronic conditions. In particular, patients with multiple chronic conditions and those who do not engage in regular physical activity require intensive health management and individualized care coordination interventions by nurses. The findings can serve as foundational evidence for expanding the coordinating role of nurses within integrated care systems and for clearly defining their roles.

The results demonstrated that only 44.7% of the study participants reported positive experiences of care coordination, which is considerably low compared to the levels of care coordination in other countries [32]. These results suggest that the care coordination function is not adequately operating in the Korean healthcare system.

It is not appropriate to assume that the uniform provision of care coordination for all patients is desirable because care coordination is determined by various factors such as patients’ health needs, clinical situations, availability of resources, and local environmental conditions [24-26]. However, patients in Korea have unrestricted access to the medical institution of their choice, and the healthcare delivery system operates in a fragmented manner. This makes it structurally difficult for care coordination to be established. In other words, the primary care system is underdeveloped, and continuity of care as well as coordination systems remain unstable. Constraints that hinder the effectiveness of care coordination include the lack of financial incentives and the non-standardization of health information systems [33], insufficient healthcare and welfare resources in rural areas [34], the dualized administrative structure between health and welfare sectors [35], and insufficient competencies of healthcare professionals in relation to care coordination [23].

To address the problem of care fragmentation, nurses’ care coordination has been repeatedly emphasized as their core roles in various national projects that are currently being carried out, such as the Primary Care Chronic Disease Management Pilot Project, the Responsible Medical Institution Discharge Patient Referral Program, and the Pilot Project for Home-Based Care. However, nurses still report various practical difficulties in performing care coordination [23]. Identifying community resources and coordinating appropriate services for patients impose a considerable workload and practical constraints on individual nurses. In addition, nurses, either individually or at the institutional level, often find it challenging to obtain sufficient compensation for these activities.

The community-based integrated care system, which will be fully implemented in 2026, will assign local governments the responsibility of organizing medical and welfare resources within their communities and, on this basis, supporting the provision of optimal services to individuals. This policy shift will further highlight the importance of care coordination, and nurses working in hospitals, clinics, and home-visit nursing service institutions are expected to play a central role in providing care coordination. Therefore, it is necessary to establish training programs to enable nurses to effectively perform the coordinating roles. Additionally, a financial incentive system should be developed to promote collaborative efforts between the medical and welfare sectors.

Looking more closely at the results, it showed that the likelihood of receiving care coordination was higher in people not currently employed, those who did not engage in regular physical activity, and those with two or more other chronic diseases in addition to hypertension or diabetes. This suggests that care coordination is being more actively provided to individuals with greater care needs, reflecting clinical necessity to some extent. These results are consistent with previous studies reporting that socioeconomic vulnerability and clinical complexity influence the implementation of care coordination [24,26]. Such vulnerable groups can serve as a key target population for nurses to more actively provide care coordination. For example, for patients with multiple chronic conditions, nurses can play a pivotal role in preventing therapeutic duplication or treatment gaps by comprehensively identifying patients’ medical history and medication status and by linking patients to appropriate medical facilities and community resources.

First, individuals who are not engaged in economic activity may have relatively more free time and thus use medical services more frequently, which may lead to increased opportunities for care coordination. In fact, unemployment has been reported to be associated with health problems, such as alcoholism, myocardial infarction, stroke, and cancer [36], and this health vulnerability of the unemployed is also reflected in the increased number of annual outpatient visits [37]. Second, physical activity promotion has been a key strategy for the management of chronic diseases, and the positive effects of exercise interventions in patients with hypertension and diabetes have been demonstrated by previous studies [38,39]. Also, several studies have reported that medical professionals use patients’ physical activity level as cues for care coordination [40,41]. This can also be interpreted as reflecting healthcare professionals’ greater recognition of the potential for intervention, given that physical activity is a modifiable factor. Lastly, it is reported that the presence of chronic disease is a significant influencing factor for care coordination [26]. In other words, in the case of patients with multimorbidity, care fragmentation could lead to various problems, such as worsening of adverse drug reactions, reduced therapeutic effectiveness, increase in inappropriate prescribing, which may ultimately lead to increased hospital admission rates and mortality rates [42]. From the perspective of healthcare professionals, patients with multiple chronic conditions often receive treatments that involve visiting various specialists and healthcare institutions and taking multiple medications. In this process, care coordination can be more actively provided to prevent confusion arising from duplicate treatments, drug–drug interactions, and conflicting medical recommendations [43].

In this context, the findings that musculoskeletal disorders related to the knee and spine accounted for the largest proportion of comorbid chronic conditions beyond hypertension and diabetes can be partly interpreted as associated with participants who did not engage in regular physical activity were significantly more likely to experience care coordination. For patients with multiple chronic conditions who have difficulty engaging in regular exercise due to knee or spine discomfort, care coordination may have occurred through referrals for pain management or physical therapy, linkages to community-based exercise promotion programs, or connections to long-term care services and national welfare programs for those with mobility limitations. This interpretation suggests that care coordination is operating in a desirable direction, grounded in actual needs.

Meanwhile, the gender gap in care coordination needs to be interpreted cautiously. Some previous studies have reported that female patients’ pain tends to be interpreted as psychological or emotional, so painkillers are less frequently prescribed to female patients than males [44]. It has also been reported that among chronic pain patients, more active treatment is recommended to male patients than female patients [45]. In other words, it may be related to the possibility that the multifaceted health needs of female patients are not adequately reflected during medical care and coordination processes. However, gender differences in care coordination experiences may also be intertwined with other factors such as age, disease characteristics, and patterns of healthcare utilization, indicating the need for more refined analyses in future research. Importantly, simple gender differences should not lead to disparities in the implementation of care coordination; rather, balanced interventions that comprehensively consider the health needs and care environments of both men and women are required.

The finding that patients with a general practitioner as their USoC were more likely to receive care coordination should be understood in light of the role and characteristics of general practitioners within the Korean healthcare system. On the surface, this may be interpreted as general practitioners being more proactive in making referrals or guiding patients to external resources. However, considering the structural particularities of the Korean healthcare system, a more cautious interpretation is warranted. In Korea, it is possible that physicians classified as general practitioners are likely to refer patients to other specialists in situations where patients’ healthcare needs exceed their scope of practice. This referral process may naturally lead to care coordination, reflecting general practitioners’ clinical judgment to flexibly respond to diverse care needs and guide patients to appropriate specialists in order to enhance access to care. In other words, general practitioners may act as coordinators by promoting the appropriate allocation of healthcare resources and continuity of patient-centered care. However, such care coordination often functions as referral-based coordination, rather than multidisciplinary collaboration or comprehensive care management, suggesting that a more cautious interpretation is needed regarding the nature of care coordination provided by general practitioners.

This study has several interpretive and methodological limitations. First, the provision of care coordination is fundamentally determined by the clinical judgment and decisions of healthcare professionals, which implies that factors beyond the variables examined in this study may have influenced its occurrence. For example, individual providers’ experiences, perceptions of patients, and attitudes toward care may have affected the delivery of care coordination, but such information could not be captured in this secondary data analysis. Similarly, in addition to the specialty of the usual source of care physician, provider- or institution-level characteristics—such as facility size, location, number of staff, and range of medical departments—may have influenced care coordination, but these factors were not sufficiently considered in this study. Moreover, the analysis did not include information on the actual distribution of healthcare and welfare resources within communities or on inter-organizational collaboration systems, limiting the ability to fully identify the structural foundations of care coordination.

Another limitation is the lack of detailed information on the content of care coordination. Specifically, it was unclear whether the care coordination reported by participants represented only simple referrals to other medical institutions or more comprehensive, multidisciplinary collaborations and ongoing management involving a range of health and social welfare resources. Without information on the specific institutions or programs to which patients were connected, the qualitative scope and practical implications of care coordination could not be fully assessed. In other words, care coordination is inherently multidimensional, extending beyond simple referrals to include patient-centered planning, interprofessional collaboration, and community-based linkages to resources. As such, a single-item measure is insufficient to capture the complexity of the concept or the depth of its actual implementation, underscoring the need for caution in interpreting its qualitative level and substantive content.

There are also limitations arising from the study design and data collection methods. The responses to the Likert-scale items used in this study were based on participants’ subjective perceptions in a self-reported format, which may be subject to biases such as recall distortion or omission. As the survey was conducted some time after outpatient visits, participants’ recall may not have been entirely accurate, and contextual factors at the time of the survey (e.g., restrictions on healthcare utilization due to COVID-19) may have influenced their responses. Furthermore, even when the same level of care coordination was provided, individual differences in perception or evaluation could have led to variations in how it was reported.

Considering these limitations, future research should adopt a more comprehensive approach that incorporates not only patient-level factors but also institutional characteristics, provider factors, and the availability of community resources that may influence care coordination. In addition, both quantitative and qualitative approaches should be considered to capture the multidimensional nature of care coordination and to enhance understanding of its substantive content.

Conclusions

This study analyzed factors influencing care coordination among patients with hypertension or diabetes who had USoC. The findings showed that care coordination was more actively provided to vulnerable groups, such as those who were economically inactive, those who did not engage in regular physical activity, and those with multiple chronic conditions. Women were less likely than men to receive care coordination, while patients with a general practitioner as their USoC physician were more likely to receive it. However, this finding should be interpreted with caution, taking into account the Korean healthcare system, its specialist-oriented structure, and the actual operation of referral systems. Given the absence of an official primary care system and the lack of a well-defined role for USoC physicians in Korea, further studies are needed to explore how care coordination is actually implemented in clinical practice, while comprehensively considering provider characteristics and community resources.

Figure 1.

Research framework.

Figure 2.

Participants selection flowchart.

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