Abstract
Continuity of care is an important quality outcome of patient care. This study aimed to investigate the relationship between personal continuity and blood pressure (BP) control among the patients with hypertension in an academic primary care centre. Between January and May 2012, we conducted a retrospective review of medical records of patients with hypertension who had been followed up for at least 1 year in the Primary Care Clinic, University of Malaya Medical Centre, Malaysia. In this setting, doctors who provided care for hypertension included postgraduate family medicine trainees, non-trainee doctors and academic staff. Systematic random sampling (1:4) was used for patient selection. BP control was defined as less than 130/80 mm Hg for patients with diabetes mellitus, proteinuria and chronic kidney disease and less than 140/90 mm Hg for all other patients. Continuity of care was assessed using the usual provider continuity index (UPCI), which is the ratio of patient visits to the usual provider to the total number of visits to all providers in 1 year. A UPC index of zero denotes no continuity while an index of one reflects perfect continuity with only the usual provider. We reviewed a total of 1060 medical records. The patients’ mean age was 62.0 years (SD 10.4). The majority was women (59.2%) and married (85.7%). The mean number of visits in a year was 3.85 (SD 1.36). A total of 72 doctors had provided consultations (55 postgraduate family medicine trainees, 8 non-trainee doctors and 9 academic staff). The mean UPCI was 0.43 (SD 0.34). Target BP was achieved in 42% of the patients. There was no significant relationship between BP control and personal continuity after adjustment for total number of visits. Continuity of care was not associated with BP control in our centre. Further studies are needed to explore the reasons for this.
Highlights
Hypertension is a major health issue responsible for 4.5% of current global disease burden [1]
The key finding of this study, where the mean usual provider continuity index (UPCI) was 0.43, was the absence of relationship between personal continuity and blood pressure (BP) control. This finding appeared to be inconsistent with our original hypothesis that personal continuity of care is associated with better BP control
An earlier study had shown that the continuity of care in hypertension was positively associated with better BP control [27]
Summary
Hypertension is a major health issue responsible for 4.5% of current global disease burden [1]. Continuity of care is widely regarded as an important component of quality health care and a core tenet of primary care [4]. Varying concepts have been developed to define and measure continuity of care [5,6]. Personal continuity stresses on patients seeing the same healthcare provider at each visit, while care continuity stresses on continuity derived from the perspectives of organisation, guidelines and medical records. The latter does not necessitate seeing the same provider at each visit [7]. The concepts for continuity of care cover informational, chronological, geographical, interdisciplinary, and interpersonal continuity [8,9]. Continuity of care has a hierarchical dimension with informational continuity being ranked the lowest, followed by longitudinal continuity and interpersonal continuity as the highest level of continuity [10]
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