Impact of continuity of care on cardiovascular disease risk among newly-diagnosed hypertension patients

Daein Choi,Kyuwoong Kim,Ahryoung Ko,Kyae Hyung Kim,Yoon Kim,Sang Min Park,Hyunho Kim,Nakhyun Kim,Jae Moon Yun,Joung Sik Son,Seulggie Choi

doi:10.1038/s41598-020-77131-w

Abstract

Several previous studies have noted benefits of maintaining continuity of care (COC), including improved patient compliance, decreased health care cost, and decreased incidence of hospitalization. However, the association of COC in hypertension patients with subsequent cardiovascular disease (CVD) risk is yet unclear. Therefore, we aimed to investigate the impact of COC on CVD risk among newly-diagnosed hypertension patients. We conducted a cohort with a study population consisted of 244,187 newly-diagnosed hypertension patients in 2004 from the Korean National Health Insurance Service database. The participants were then divided into approximate quartiles of COC index, and followed from 1 January 2007 until 31 December 2017. Cox proportional hazards models were used to evaluate the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for CVD risk according to quartiles. Compared to patients within the lowest quartile of COC index, those within the highest quartile of COC index had reduced risk for CVD (aHR 0.76, 95% confidence interval; CI 0.73–0.79), CHD (aHR 0.66, 95% CI 0.62–0.69) and stroke (aHR 0.84, 95% CI 0.80–0.88). COC among hypertension patients was associated with improved medication compliance and reduced risk of stroke and CVD. The importance of maintaining COC should be emphasized to reduce the risk of CVD among hypertension patients.

Highlights

Several previous studies have noted benefits of maintaining continuity of care (COC), including improved patient compliance, decreased health care cost, and decreased incidence of hospitalization
In this nationwide population-based study among 244,187 newly-diagnosed hypertension patients, we have shown that COC was associated with reduced risk of cardiovascular disease (CVD)
We have applied an intuitive measure of COC, the number of medical institutions utilized, to evaluate the CVD risk associated with COC

Summary

Introduction

Several previous studies have noted benefits of maintaining continuity of care (COC), including improved patient compliance, decreased health care cost, and decreased incidence of hospitalization. COC among hypertension patients was associated with improved medication compliance and reduced risk of stroke and CVD. Continuity of care (COC), which generally refers to the relationship between patient and their physician o vertime[8], is known to improve quality of care and patient c ompliance[9,10] Despite these benefits, not having COC on patients with chronic disease is common, especially in Asian countries where primary care physician is not established commonly[11]. Previous studies investigated the effect of COC among hypertension patients focused on the outcomes of blood pressure c ontrol[12], medication c ompliance[13], health care c ost[7], and incidence of hospital a dmission[14]. We evaluated the association of COC with medication compliance as a secondary outcome as well

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Results

Conclusion