Abstract
BackgroundA growing number of health care providers are nowadays involved in heart failure care. This could lead to discontinuity and fragmentation of care, thus reducing trust and hence poorer medication adherence. This study aims to explore heart failure patients’ experiences with continuity of care, and its relation to medication adherence.MethodsWe collected data from 327 primary care patients with chronic heart failure. Experienced continuity of care was measured using a patient questionnaire and by reviewing patients’ medical records. Continuity of care was defined as a multidimensional concept including personal continuity (seeing the same doctor every time), team continuity (collaboration between care providers in general practice) and cross-boundary continuity (collaboration between general practice and hospital). Medication adherence was measured using a validated patient questionnaire. The relation between continuity of care and medication adherence was analysed by using chi-square tests.ResultsIn total, 53% of patients stated not seeing any care provider in general practice in the last year concerning their heart failure. Of the patients who did contact a care provider in general practice, 46% contacted two or more care providers. Respectively 38% and 51% of patients experienced the highest levels of team and cross-boundary continuity. In total, 14% experienced low levels of team continuity and 11% experienced low levels of cross-boundary continuity. Higher scores on personal continuity were significantly related to better medication adherence (p < 0.01). No clear relation was found between team- or cross-boundary continuity and medication adherence.ConclusionsA small majority of patients that contacted a care provider in general practice for their heart failure, contacted only one care provider. Most heart failure patients experienced high levels of collaboration between care providers in general practice and between GP and cardiologist. However, in a considerable number of patients, continuity of care could still be improved. Efforts to improve personal continuity may lead to better medication adherence.
Highlights
A growing number of health care providers are nowadays involved in heart failure care
Analysis First, we explored the results on the items measuring personal, team and cross-boundary continuity
We found a non-linear relation between experienced team continuity and medication adherence: both high and low levels of team continuity were associated with maximum medication adherence, while the mid-levels of team continuity were associated with the lowest medication adherence (p = 0.04)
Summary
A growing number of health care providers are nowadays involved in heart failure care. This could lead to discontinuity and fragmentation of care, reducing trust and poorer medication adherence. For patients with a chronic disease, recent developments in care can result in lack of continuity. Nurse physicians and practice nurses are often involved in the care for chronically ill patients. This could lead to discontinuity and fragmentation of care, which in turn may reduce trust and result in poorer medication adherence [10,11]. Communication and cooperation between all providers involved becomes increasingly important to guarantee continuity [12,13,14,15]
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