Abstract
BackgroundHigher continuity of GP care (CGPC), that is, consulting the same doctor consistently, can improve doctor–patient relationships and increase quality of care; however, its effects on patients with dementia are mostly unknown.AimTo estimate the associations between CGPC and potentially inappropriate prescribing (PIP), and with the incidence of adverse health outcomes (AHOs) in patients with dementia.Design and settingA retrospective cohort study with 1 year of follow-up anonymised medical records from 9324 patients with dementia, aged ≥65 years living in England in 2016.MethodCGPC measures include the Usual Provider of Care (UPC), Bice–Boxerman Continuity of Care (BB), and Sequential Continuity (SECON) indices. Regression models estimated associations with PIPs and survival analysis with incidence of AHOs during the follow-up adjusted for age, sex, deprivation level, 14 comorbidities, and frailty.ResultsThe highest quartile (HQ) of UPC (highest continuity) had 34.8% less risk of delirium (odds ratio [OR] 0.65, 95% confidence interval [CI] = 0.51 to 0.84), 57.9% less risk of incontinence (OR 0.42, 95% CI = 0.31 to 0.58), and 9.7% less risk of emergency admissions to hospital (OR 0.90, 95% CI = 0.82 to 0.99) compared with the lowest quartile. Polypharmacy and PIP were identified in 81.6% (n = 7612) and 75.4% (n = 7027) of patients, respectively. The HQ had fewer prescribed medications (HQ: mean 8.5, lowest quartile (LQ): mean 9.7, P<0.01) and had fewer PIPs (HQ: mean 2.1, LQ: mean 2.5, P<0.01), including fewer loop diuretics in patients with incontinence, drugs that can cause constipation, and benzodiazepines with high fall risk. The BB and SECON measures produced similar findings.ConclusionHigher CGPC for patients with dementia was associated with safer prescribing and lower rates of major adverse events. Increasing continuity of care for patients with dementia may help improve treatment and outcomes.
Highlights
Dementia affects 2–3% of 65-year-olds, and 30–50% of people aged ≥85 years.[1,2] Patients diagnosed with dementia often have additional health conditions that complicate treatment plans, placing them at higher risk of polypharmacy and potentially inappropriate prescribing (PIP),[3,4] and are more dependent on healthcare services.[5]Continuity of GP care (CGPC) refers to care over time by the same GP
Higher CGPC for patients with dementia was associated with safer prescribing and lower rates of major adverse events
Clinical Practice Research Datalink (CPRD) data linked to NHS Hospital Episode Statistics (HES) admission data, the UK government Office for National Statistics death certificate register, and quintiles of English Index of Multiple Deprivation based on individual postcode were used
Summary
Continuity of GP care (CGPC) refers to care over time by the same GP. Continuity of care fosters a good working relationship between patient and doctor, and a sense of responsibility, especially if the GP is the named and accountable GP.[6,7] Lower continuity of care is associated with poorer medication management[8] and worse health outcomes, including increased mortality.[9,10] Improving care for patients with dementia is regarded as a priority for healthcare delivery.[11] limited evidence is available on the relationship between CGPC, treatment, and health outcomes in dementia. GP care (CGPC), that is, consulting the same doctor consistently, can improve doctor–patient relationships and increase quality of care; its effects on patients with dementia are mostly unknown
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
