Continuity of care associated with improved prescribing for patients at risk for heart disease

People at risk for heart disease are more likely to be prescribed relevant medications if they see the same primary care physician over time (known as continuity of care), but are less likely to take their medications (known as adherence), according to researchers at the University of Bristol.

The National Institute for Health and Care Research (NIHR)-funded study, published in BMJ Open, found strong evidence that prescribing clinically relevant medications such as statins (used to lower cholesterol), anticoagulants, and antiplatelet agents (both used as blood thinners) and antihypertensive drugs (for lowering blood pressure) increased with greater continuity of care. These drugs are widely used and, if properly prescribed and taken by patients correctly, can help reduce the risk of heart disease and stroke.

The researchers analyzed the records of 173,993 randomly selected patients who had four or more GP consultations in the previous two years, using data from a large UK database of electronic health records. Five categories of continuity of care were used in the study: no continuity, below average, average, above average and perfect continuity. Continuity of care is valued by patients and considered important by many experts for improving the quality of care patients receive.

Patients aged 65 years or older without a diagnosis of cardiovascular disease (CVD) related conditions, with no or below-average continuity of care, were 10%-27% less likely to receive statins than comparable patients with above-average continuity of care.

Patients aged 30 years or older diagnosed with CVD-related conditions with poorer continuity of care were 9%-23% less likely to receive statins than comparable patients with above-average continuity of care.

Continuity of care was generally not associated with better adherence, with the exception of some weak evidence of greater adherence to statins used to treat people with heart disease.

dr. Peter Tammes, of the Center for Academic Primary Care at the University of Bristol and lead author of the study, said: “This is the first time the association between continuity of care, prescribing and adherence has been described. Although we cannot prove a causal relationship , our findings suggest that prescribing important cardiovascular medications may be positively influenced by improved continuity of primary care.There is less evidence for better adherence to ongoing medication, which was a surprising result.

“We also expected that perfect continuity of care might be associated with poorer prescribing and adherence, due to over-familiarity between the patient and GP, but reassuringly, our findings do not support this.”

dr. Rupert Payne, associate professor of primary care and clinical pharmacology at the Center for Academic Primary Care at the University of Bristol and senior co-author, said: “This study shows the potential for continuity of care to improve GP prescribing. We encourage clinicians and policy makers to consider strategies to increase continuity of care with this goal in mind. Future research should explore the reasons for these findings in more detail and consider whether continuity may also affect other relevant aspects of medication use, including drug safety and overprescribing.”

Paper:

‘Relationship between continuity of primary care and both prescribing and adherence to common cardiovascular medications: a cohort study of patients in England’ by Peter Tammes et al. Published in BMJ Open. Sep 2022.

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