Effects of Continuity of Care on Medication Duplication Among the Elderly

Cheng, Shou‐Hsia; Chen, Chi‐Chih

doi:10.1097/mlr.0000000000000042

Cited by 41 publications

(47 citation statements)

References 36 publications

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“…The association between COC and adherence was demonstrated by previous studies. [27,28,45] According to the study by Warren et al [28] , a usual provider continuity index (UPI) of ≥75% was associated with an increased likelihood of adherence. Chen et al [27] reported that patients with higher continuity of care index (COCI) scores were more likely to adhere to medications than those with lower COCI scores.…”

Section: Discussionmentioning

confidence: 99%

“…The probability of hospitalization for patients with high COCI scores was significantly lower than that for those with low COCI scores. [27] Furthermore, Cheng and Chen [45] reported that the COC, either at the physician or institution level, was negatively associated with duplicated medications. In our study, compared with the patients who changed their preferred clinic, those who did not showed higher rates of appropriate adherence and persistence, suggesting that the magnitudes of improvements in adherence and persistence are related to the COC at the clinic level.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of the chronic disease management program for appropriateness of medication adherence and persistence in hypertension and type-2 diabetes patients in Korea

Kim

Kim²,

Lee³

2017

Medicine

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The chronic disease management program (CDMP), a multilevel intervention including copayment reduction and physician incentives, was introduced in 2012 in Korea to improve blood pressure and glycemic control by strengthening the function of clinic as primary care institutions in managing hypertension and diabetes. This study, therefore, aimed to evaluate the effect of CDMP on the appropriateness of medication adherence and persistence in hypertension or type-2 diabetes patients.A pre-post retrospective study was conducted using claims cohort data from 2010 to 2013. Hypertension or type-2 diabetes patients were selected as the CDMP group, while dyslipidemia patients were the control group. Study groups were further categorized as clinic shifters or non-shifters on the basis of whether hospital use changed to clinic use during the study period. Prepost changes in adherence and persistence were assessed. Adherence was measured by medication possession ratio (MPR) and categorized as under (<0.8), appropriate (0.8-1.1), and over-adherence (>1.1). Persistence was measured by 12-month cumulative persistence rate.The pre-post change was significantly improved for appropriate-adherence (hypertension, +6.0%p; diabetes, +6.1%p), 12-month cumulative persistence (hypertension, +6.5%p; diabetes, +10.8%p), and over-adherence (hypertension, À5.3%p; diabetes, À2.8% p) only among the shifters in the CDMP group. Among these, patients visiting the same, single clinic showed a significant increase in appropriate-adherence, whereas those who changed their clinics showed a nonsignificant increase. No significant improvement was verified among the non-shifters in the CDMP group.CDMP improved medication adherence and persistence by significantly increasing appropriate-adherence and 12-month cumulative persistence rate in hypertension and type-2 diabetes patients. Particularly, CDMP significantly improved over-adherence, which was associated with increasing healthcare costs and hospitalization risk.Abbreviations: AHDs = antihypertensive drugs, BP = blood pressure, CDMP = chronic disease management program, COC = continuity of care, COCI = continuity of care index, CVD = cardiovascular disease, HbA1c = hemoglobin A1c, KNHIS-NSC = Korea National Health Insurance Service-National Sample Cohort, LLDs = lipid-lowering drugs, MPR = medication possession ratio, OADs = oral antidiabetes drugs, PDC = proportion of days covered, UPI = usual provider continuity index.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evaluation of the chronic disease management program for appropriateness of medication adherence and persistence in hypertension and type-2 diabetes patients in Korea

Kim

Kim²,

Lee³

2017

Medicine

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“…Furthermore, selection bias is a significant problem when assessing the effect of continuity of care. Four related studies have considered this type of bias [13, 19, 22, 44], whereas the vast majority of previous studies have neglected it. In this study, selection bias was controlled via kernel-based propensity score matching.…”

Section: Discussionmentioning

confidence: 99%

“…The effects of continuity of care have been debated in previous studies because some have concluded that continuity of care is associated with fewer hospitalizations, emergency department visits, and hospital admissions [3–7]; low pharmaceutical expenditures and healthcare expenses [5, 8–10]; decreased mortality rates [11, 12]; fewer duplicated medications [13]; improved medication adherence [14]; and patient satisfaction [15–18]. However, others insist that high continuity of care may lead to the purchase of more drugs overall and that the effects on HRQoL are unclear; thus, these should be further examined [19, 20].…”

Section: Introductionmentioning

confidence: 99%

Effect of continuity of care on health-related quality of life in adult patients with hypertension: a cohort study in China

Sun

Tang

et al. 2016

BMC Health Serv Res

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BackgroundContinuity of care is widely considered a principle of primary care that decreases healthcare utilization and mortality. However, the effect of continuity of care on health-related quality of life (HRQoL) for adult patients with hypertension remains unclear.MethodsTo further evaluate the effect of continuity of care, we implemented a cohort study among hypertensive patients aged over 35 years (n = 1200) in six townships in Qianjiang District, Chongqing, China, between 2012 and 2014. The study ultimately included 1079 participants. The continuity of care index was calculated using claim-based longitudinal data obtained from hypertension follow-up service records. The baseline and endline survey-based data, tested by the SF-36 scale, were used to assess HRQoL. To control selection bias and examine the effect of continuity of care, a kernel-based propensity score matching difference-in-differences (DID) method was used. Additionally, descriptive statistics, chi-squared test, and Mann–Whitney nonparametric test were used to summarize characteristics, evaluate proportional differences, and analyze statistical differences, respectively.ResultsOur results showed that patients in the high continuity of care group presented greater improvement in both Physical Component Summary (PCS, DID = 5.192 ± 1.970, p < 0.001) and Mental Component Summary (MCS, DID = 7.900 ± 1.815, p = 0.008) than those in the low continuity of care group. Moreover, patients in the high continuity of care group showed significant improvement in physical functioning, role-physical, general health, role-emotional, and mental health.ConclusionsOur findings indicate that a long-term physician-patient relationship may improve HRQoL in patients with hypertension. However, more unified measurement tools are needed to evaluate continuity of care. Further studies should include more study settings.

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“…1,2 A better patient-doctor relationship has also been suggested to reduce avoidable admissions, 13 healthcare costs, 14 and duplication of medications. 15 A review by Eveleigh et al in 2012 found 19 different instruments used to measure the patient-doctor relationship. 6 These measures often assess the longitudinal element of the relationship by determining how long a patient has been seeing a particular GP, and how often.…”

Section: Introductionmentioning

confidence: 99%

Depth of the patient–doctor relationship and content of general practice consultations: cross-sectional study

et al. 2015

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Effects of Continuity of Care on Medication Duplication Among the Elderly

Abstract: Improving either physician continuity or site continuity may result in fewer duplicated medications, particularly for patients with MCCs.

Cited by 41 publications

References 36 publications

Evaluation of the chronic disease management program for appropriateness of medication adherence and persistence in hypertension and type-2 diabetes patients in Korea

Evaluation of the chronic disease management program for appropriateness of medication adherence and persistence in hypertension and type-2 diabetes patients in Korea

Effect of continuity of care on health-related quality of life in adult patients with hypertension: a cohort study in China

Depth of the patient–doctor relationship and content of general practice consultations: cross-sectional study

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