Long-term Continuity Of Care Research Articles

Continuity and discontinuity of care among older patients in Danish general practice: a retrospective cohort study.

Continuity of care (COC) for older adults has been associated with lower use of healthcare services, decreased risk of hospitalisation, and lower mortality. However, research on COC in older adults is limited by short time periods and small sample sizes. Long-term COC can only develop if the patient stays with the general practice for ≥10 years. Therefore, research that focuses on long duration and broader populations is needed. To measure the extent of longitudinal site-level COC in general practice and listing duration of the patient-general practice relation for all older Danish citizens. Retrospective cohort study of all patients aged ≥65 years on 31 December 2021 listed with a Danish general practice (N = 1 144 941 persons). Individual-level register data were used on start and end dates for listing with a general practice to analyse site-level COC by number of changes and listing duration of the patient-general practice relation from January 2007-December 2021. During the 15 years, 39.3% of older adults did not change general practice. Among the remaining 60.7%, who experienced discontinuity of care, 34.0% changed once, 16.3% changed twice, and 6.3% changed three times. Overall, <5% changed general practice >3 times. The duration of the patient-general practice relations were on average 9.5 years. Overall, 27.5% lasted 0-4 years, 33.7% lasted 5-9 years, and 38.8% lasted ≥10 years. Danish general practice provides high levels of site-level COC for their older patients. On average, patients aged ≥65 years changed general practice once and had a patient-general practice relation length of 9.5 years.

Teleconsultation in orthopaedic surgery: A systematic review and meta-analysis of patient and physician experiences

Introduction The primary purpose of this review was to evaluate patient and physician preference and satisfaction for teleconsultation in orthopaedic surgery compared to traditional face-to-face consultation. In addition, we evaluated the effects of teleconsultation on patient length of visit, healthcare costs, range of motion (ROM), pain, quality of life (QOL), and ongoing management plans. Methods A systematic review of MEDLINE, Embase, Web of Science, and Cochrane Library was conducted according to PRISMA guidelines. Randomised control trials and case control studies comparing teleconsultation with traditional, face-to-face consultation in the management of orthopaedic conditions were included. The primary outcome measures were patient and physician preference and satisfaction. Secondary outcomes included patient length of visit, healthcare costs, ROM, pain, QOL, and ongoing management plans. Results A total of 13 articles meeting the eligibility criteria were included for systematic review and 8 for meta-analysis. There was no significant difference in patient satisfaction, length of visit, or time spent with the physician between the telemedicine and in-office control group. The mean difference of patient preference for telemedicine was significantly higher in the telemedicine group compared to the in-office visit group (OR 1.44, 95% CI 1.12–1.87, p = 0.005). Discussion Telemedicine was not inferior to face-to-face office visits in regard to patient and physician preference and satisfaction. Therefore, it would be an effective adjunct to face-to-face office visits, serving as a mechanism of triage and long-term continuity of care.

Unique Digital Care Interactions of Diabetes Patients with Remote Health Coach through Apollo Sugar App to Achieve Positive Glycemic Control Outcomes

Aim: To evaluate the quality and meaningful interactions of patients with type 2 diabetes mellitus (T2DM) with health coach through Apollo Sugar App and its effects on clinical outcomes. Methods: Apollo Sugar Clinics is a pan-India chain of state of art, integrated care network of diabetes specialty clinics. The current analysis includes digital data of health interactions captured through a novel, unique and well-designed Apollo Sugar App. of great utility value. These live health interactions were between Sugar health coaches and 10,000 patients with T2DM, registered at Apollo Sugar Clinics who downloaded the Apollo Sugar App from Google Play store for the last 6 months. Meaningful health interactions with health coach were identified in 317 patients which were categorized into medication, diet, exercise, and self-monitoring blood glucose (SMBG). Descriptive statistics was applied to analyze the data, to assess clinical outcomes. Results: A total of 10800 health interactions were captured, of which 2000 quality interactions were categorized as meaningful interactions. Among these interactions 29% on diet, 21% on exercise, 19% on medication change, 4% on insulin dose, 2% on hypoglycemia and 25% on meaningful use of SMBG data. SMBG was performed &amp;gt;2times/week by 65% of study population. Pre-meal and post-meal SMBG target were achieved in 35% and 24% of patients, respectively. 28% achieved control reductions in &amp;lt;2 weeks and no hypoglycemic episodes occurred in any of the patients. There was a considerable reduction in mean HbA1c (-0.7%), fasting plasma glucose (-41.5mg/dL) and post-prandial glucose (-100.7mg/dL) at 3 months follow-up. Conclusions: The current analysis indicates that patient interactions with health coach through an Apollo Sugar app is a modern improved method of behavioral and clinical care, to achieve long term continuity of care for change in outcome of hard end points. Disclosure S. Shah: None. R. Mehrotra: None. S. Das: None. R.S. Erukulapati: None. S.P. Reddy: None. J. Jayaprakashsai: None. K. Dash: None. B. Jaganmohan: None. U. Ayyagari: None. S. Tippisetty: None. V.K. Kolukula: None. S. Joshi: None.

Effects of long-term high continuity of care on avoidable hospitalizations of chronic obstructive pulmonary disease patients

ObjectiveTo examine the effects of high continuity of care (COC) maintained for a longer time on the risk of avoidable hospitalization of patients with chronic obstructive pulmonary disease (COPD). MethodsA retrospective cohort study design was adopted. We used a claim data regarding health care utilization under a universal health insurance in Taiwan. We selected 2199 subjects who were newly diagnosed with COPD. We considered COPD-related avoidable hospitalizations as outcome variables. The continuity of care index (COCI) was used to evaluate COC as short- and long-term COC. A logistic regression model was used to control for sex, age, low-income status, disease severity, and health status. ResultsLong-term COC had stronger effect on health outcomes than short-term COC did. After controlling for covariables, the logistic regression results of short-term COC showed that the medium COCI group had a higher risk of avoidable hospitalizations (adjusted odds ratio [AOR]: 1.89, 95% CI: 1.07–3.33) than the high COCI group did. The results of long-term COC showed that both the medium (AOR: 1.98, 95% CI: 1.0–3.94) and low (AOR: 2.03, 95% CI: 1.05–3.94) COCI groups had higher risks of avoidable hospitalizations than did the high COCI group. ConclusionsMaintaining long-term high COC effectively reduces the risk of avoidable hospitalizations. To encourage development of long-term patient–physician relationships could improve health outcomes.

A Narrative Review of Diabetes Intervention Studies to Explore Diabetes Care Opportunities for Pharmacists.

Background. We conducted a review of current diabetes intervention studies in type 2 diabetes and identified opportunities for pharmacists to deliver quality diabetes care. Methods. A search on randomised controlled trials (RCT) on diabetes management by healthcare professionals including pharmacists published between 2010 and 2015 was conducted. Results and Discussion. Diabetes management includes multifactorial intervention which includes seven factors as outlined in diabetes guidelines, namely, glycaemic, cholesterol and blood pressure control, medication, lifestyle, education, and cardiovascular risk factors. Most studies do not provide evidence that the intervention methods used included all seven factors with exception of three RCT which indicated HbA1c (glycated hemoglobin) reduction range of 0.5% to 1.8%. The varied HbA1C reduction suggests a lack of standardised and consistent approach to diabetes care. Furthermore, the duration of most studies was from one month to two years; therefore long term outcomes could not be established. Conclusion. Although pharmacists' contribution towards improving clinical outcomes of diabetes patients was well documented, the methods used to deliver structured, consistent evidence-based care were not clearly stipulated. Therefore, approaches to achieving long term continuity of care are uncertain. An intervention strategy that encompass all seven evidence-based factors will be useful.

Improving Survival Rates of Patients With Idiopathic Dilated Cardiomyopathy in Tuscany Over 3 Decades

Background— Contemporary therapeutic options have led to substantial improvement in survival of patients with heart failure. However, limited evidence is available specifically on idiopathic dilated cardiomyopathy. We thus examined changes in prognosis of a large idiopathic dilated cardiomyopathy cohort systematically followed during the past 30 years. Methods and Results— From 1977 to 2011, 603 consecutive patients (age, 53±12 years; 73% men; left ventricular ejection fraction, 32±10%) fulfilling World Health Organization criteria for idiopathic dilated cardiomyopathy, including negative coronary angiography, were followed up for 8.8±6.3 years. Patients were subdivided in 4 enrollment periods on the basis of heart failure treatment eras: (1) 1977–1984 (n=66); (2) 1985–1990 (n=102); (3) 1991–2000 (n=197); (4) 2001–2011 (n=238). Rates of patients receiving angiotensin-converting enzyme inhibitors/angiotensin receptors blockers, β-blockers, and devices at final evaluation increased from 56%, 12%, 8% (period 1) to 97%, 86%, 17% (period 4), respectively ( P &lt;0.05). There was a trend toward enrollment of older patients with less severe left ventricular dilatation and dysfunction during the years. During follow-up, 271 patients (45%) reached a combined end point including death (heart failure related, n=142; sudden death, n=71; and noncardiac, n=22) or cardiac transplant (n=36). A more recent enrollment period represented the most powerful independent predictor of favorable outcome {period 2 versus 1 (hazard ratio [HR], 0.64; P =0.04), period 3 versus 1 (HR, 0.35; P &lt;0.001), period 4 versus 1 (HR, 0.14; P &lt;001)}. Each period was associated with a 42% risk reduction versus the previous one (HR, 0.58; 95% confidence interval, 0.50–0.67; P &lt;0.001), reflecting marked decreases in heart failure–related mortality and sudden death (period 4 versus 1: HR, 0.10; P &lt;001 and HR, 0.13; P &lt;0.0001, respectively). Conclusions— Evidence-based treatment has led to dramatic improvement in the prognosis of idiopathic dilated cardiomyopathy during the past 3 decades. The benefits of controlled randomized trials can be replicated in the real world, emphasizing the importance of tailored follow-up and long-term continuity of care.

S.03.01 Clinical neuroproteomics and biomarkers of Alzheimer's disease

The Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) is a long-term study designed to find out which treatments are most effective for treating bipolar disorder [1]. STEP-BD is the largest treatment study ever conducted for bipolar disorder and enrolled 4,360 participants from 22 sites over seven years (1998 to 2005). The program included several different studies, each aimed at a different aspect of treatment for the illness. STEP-BD recruited real-world patients contending with multiple mental and/or physical illnesses and offered participants long-term continuity of care. Once enrolled, participants received care for as long as they were in the program (up to five years) and were monitored systematically for the entire period. Clinicians participating in STEP-BD were extensively trained in the use of evidence-based treatments to become certified. STEP-BD’s rigorous treatment and measurement process, known as the ‘Best Practice Pathway’, allowed clinicians to reliably evaluate their patients’ full range of symptoms and monitor the course of the illness. The findings from the STEP-BD study have provided much needed long-term data on the chronic, recurrent course of the disorder, and given a precious contribute to building an evidence-base on the best treatments for the disorder. The presentation will review the benefits and pitfalls of the STEP BD study, with special reference to the lessons for future studies in general and to the ENBREC approaches to bipolar research and clinical management in particular.

Veterans Affairs Health System and mental health treatment retention among patients with serious mental illness: evaluating accessibility and availability barriers.

We examine the impact of two dimensions of access-geographic accessibility and availability-on VA health system and mental health treatment retention among patients with serious mental illness (SMI). Among 156,631 patients in the Veterans Affairs (VA) health care system with schizophrenia or bipolar disorder in fiscal year 1998 (FY98), we used Cox proportional hazards regression to model time to first 12-month gap in health system utilization, and in mental health services utilization, by the end of FY02. Geographic accessibility was operationalized as straight-line distance to nearest VA service site or VA psychiatric service site, respectively. Service availability was assessed using county-level VA hospital beds and non-VA beds per 1,000 county residents. Patients who died without a prior gap in care were censored. There were 32, 943 patients (21 percent) with a 12-month gap in health system utilization; 65,386 (42 percent) had a 12-month gap in mental health services utilization. Gaps in VA health system utilization were more likely if patients were younger, nonwhite, unmarried, homeless, nonservice-connected, if they had bipolar disorder, less medical morbidity, an inpatient stay in FY98, or if they lived farther from care or in a county with fewer VA inpatient beds. Similar relationships were observed for mental health, however being older, female, and having greater morbidity were associated with increased risks of gaps, and number of VA beds was not significant. Geographic accessibility and resource availability measures were associated with long-term continuity of care among patients with SMI. Increased distance from providers was associated with greater risks of 12-month gaps in health system and mental health services utilization. Lower VA inpatient bed availability was associated with increased risks of gaps in health system utilization. Study findings may inform efforts to improve treatment retention.

Social psychiatry in the United Kingdom: the approach to schizophrenia.

British contributions to theoretical and applied social psychiatry have been determined in large part by a traditional empiricism and by developments in social welfare legislation over the past 70 years. The establishment of a national health service covering the whole population and the attempt to provide comprehensive social services have created special opportunities for epidemiological research and for practical community psychiatry. These developments have by no means been uniform throughout the country, and there has been plenty of scope for individual initiative. Open-door policies, domiciliary visiting, social and occupational rehabilitation, therapeutic communities, and long-term continuity of care were first introduced in pioneering centers and subsequently adopted elsewhere. The idea that disorders such as schizophrenia not only have the character of acute illnesses but can also take the form of chronic disabilities has led to recognition of the fact that services must be tailored to the needs of individuals, and to an emphasis on the importance of the family and other social environments. There is a readiness to capitalize on successes and to learn from mistakes, assisted by a wide range of evaluative studies, which promises well for the future.