Abstract
Continuity of care (COC) is considered an important determinant of medication adherence based on measures such as the usual provider continuity index (UPCI) that are derived exclusively from physician visit claims. This study aimed to: a) determine if high UPCI values predict physicians who deliver different clinical services; and b) compare UPCI with an integrated COC measure capturing physician visits, prescribing, and a complete medical examination in a multivariable model of patients receiving statin medications. This was a retrospective cohort study of new statin users between 2012 and 2017 in Saskatchewan, Canada. We calculated sensitivity/specificity of a high UPCI value for predicting physicians who were prescribers of statins and/or providers of complete medical examinations. Next, we used logistic regression models to test two measures of COC (high UPCI value or an integrated COC measure) on the outcome of optimal statin adherence (proportion of days covered ≥80%). The DeLong test was used to compare predictive performance of the two models. Among 55,144 new statin users, a high UPCI was neither a sensitive or specific marker of physicians who prescribed statins or performed a complete medical examination. The integrated COC measure had a stronger association with optimal adherence [adjusted odds ratio (OR) = 1.56, 95% confidence interval (CI) 1.50 to 1.63] than UPCI (adjusted OR = 1.23, 95% CI 1.19 to 1.28), and improved predictive performance of the adherence model. The number of physician visits alone appears to be insufficient to represent COC. An integrated measure improves predictive performance for optimal medication adherence in patients initiating statins.
Highlights
Non-adherence is defined as the failure to take medications according to the prescribed regimen [1]
The integrated continuity of care (COC) measure had a stronger association with optimal adherence [adjusted odds ratio (OR) = 1.56, 95% confidence interval (CI) 1.50 to 1.63] than usual provider continuity index (UPCI), and improved predictive performance of the adherence model
We described the baseline characteristics of the study cohort using descriptive statistics for all patients as well as subgroups based on COC measured by UPCI and the integrated COC measure
Summary
Non-adherence is defined as the failure to take medications according to the prescribed regimen [1]. It occurs in up to half of all people with chronic conditions and is responsible for $100 to 500 billion in avoidable healthcare costs annually in the US [2]. Patients exhibiting non-adherence experience higher rates of hospitalization, death, and higher healthcare costs [3–5]. Despite a strong theoretical framework, understanding how healthcare practices precisely influence adherence remains a challenge. Studies suggest that individual physicians can improve medication adherence by establishing continuity of care (COC) for their patients [6–9]. The precise nature of this association is unknown but is likely mediated by factors promoting a strong relationship between patients and physicians [10, 11]. An ongoing relationship between a physician and a patient is associated with higher satisfaction, improved trust, and more effective communication [12]. Having a single physician helps ensure the completeness of a patient’s health records, and can facilitate the coordination of disease management activities [13]
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