Abstract
PurposeDeficiencies in medication adherence are a major barrier to effectiveness of chronic condition management. Continuity of primary care may promote adherence. We assessed the association of continuity of primary care with adherence to long-term medication as exemplified by statins.Research DesignWe linked data from a prospective study of 267,091 Australians aged 45 years and over to national data sets on prescription reimbursements, general practice claims, hospitalisations and deaths. For participants having a statin dispense within 90 days of study entry, we computed medication possession ratio (MPR) and usual provider continuity index (UPI) for the subsequent two years. We used multivariate Poisson regression to calculate the relative risk (RR) and 95% confidence interval (CI) for the association between tertiles of UPI and MPR adjusted for socio-demographic and health-related patient factors, including age, gender, remoteness of residence, smoking, alcohol intake, fruit and vegetable intake, physical activity, prior heart disease and speaking a language other than English at home. We performed a comparison approach using propensity score matching on a subset of the sample.Results36,144 participants were eligible and included in the analysis among whom 58% had UPI greater than 75%. UPI was significantly associated with 5% increased MPR for statin adherence (95% CI 1.04–1.06) for highest versus lowest tertile. Dichotomised analysis using a cut-off of UPI at 75% showed a similar effect size. The association between UPI and statin adherence was independent of socio-demographic and health-related factors. Stratification analyses further showed a stronger association among those who were new to statins (RR 1.33, 95% CI 1.15–1.54).ConclusionsGreater continuity of care has a positive association with medication adherence for statins which is independent of socio-demographic and health-related factors.
Highlights
Poor adherence to long-term medication is a major issue undermining effective delivery of healthcare.[1]
Greater continuity of care has a positive association with medication adherence for statins which is independent of socio-demographic and health-related factors
Model 2 analysis stratified by language other than English spoken at home showed that increased continuity had a greater impact among people who spoke a language other than English at home as compared to people who spoke only English at home (RR 1.03, 95% confidence interval (CI) 1.02–1,05 and relative risk (RR) 1.04, 95% CI 1.03–1.06), to a lesser extent than in people who were new to statins
Summary
36,144 participants were eligible and included in the analysis among whom 58% had UPI greater than 75%. UPI was significantly associated with 5% increased MPR for statin adherence (95% CI 1.04–1.06) for highest versus lowest tertile. The association between UPI and statin adherence was independent of socio-demographic and health-related factors. The authors thank the men and women participating in the 45 and Up Study, which is owned and managed by the Sax Institute, Sydney, NSW (www.saxinstitute.org.au) in collaboration with major partner Cancer Council NSW and other partners which, at the time of writing, include: National Heart Foundation of Australia (NSW Division), NSW Ministry of Health, beyondblue, Ageing, Disability and Home Care, Department of Family and Community Services, the Australian Red Cross Blood Service and UnitingCare Ageing.
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