Prescriber continuity and medication availability in older adults with cardiometabolic conditions

Abstract

Background:Many older adults have multiple conditions and see multiple providers, which may impact their use of essential medications.Objective:We examined whether the number of prescribers of these medications was associated with the availability of medications, a surrogate for adherence, to manage diabetes, hypertension or dyslipidemia.Methods:A retrospective cohort of 383,145 older adults with diabetes, hypertension or dyslipidemia in the US Medicare program living in 10 states. The association between the number of prescribers of cardiometabolic medications in 2010 and medication availability (proportion of days with medication on hand) in 2011 was estimated via logistic regression, controlling for patient demographic characteristics and chronic conditions.Results:Medicare beneficiaries with diabetes, hypertension and/or dyslipidemia had an average of five chronic conditions overall, obtained 10–12 medications for all conditions and most often had one prescriber of cardiometabolic medications. In adjusted analyses, the number of prescribers was not significantly associated with availability of oral diabetes agents but having more prescribers is associated with increased medication availability in older Medicare beneficiaries with dyslipidemia or hypertension.Conclusion:The incremental addition of new prescribers may be clinically reasonable for complex patients but creates the potential for coordination problems and informational discontinuity over time. Health systems may want to identify complex patients with multiple prescribers to minimize care fragmentation.

Prescriber Continuity and Disease Control of Older Adults

“…First, seeing multiple prescribers could adversely impact disease control via non-adherence to medications or lifestyle change recommendations. In separate analyses of this cohort, we found a null association between availability of oral diabetes medications and number of prescribers, 32 which suggests that the medication non-adherence pathway to disease control may not be an important factor. It is possible that patients with multiple prescribers have worse disease control due to non-adherence to lifestyle recommendations.…”

A Novel Approach to Developing a Discordance Index for Older Adults With Chronic Kidney Disease

“…Renally inappropriate prescribing may be evidence of discordance because it indicates the treatment of a co-occurring condition in conflict with appropriate treatment in CKD. The number of medication prescribers was used as a proxy for continuity of care that is easily calculated and shown to be associated with poor outcomes (18). Information on medication usage and the number of prescribers was measured between 1 year prior to and 30 days after the index date to identify prescriptions at the time of the index date.…”

General practice and patient characteristics associated with personal continuity: a mixed-methods study

“…Personal continuity implies familiarity and mutual confidence between patient and doctor that can and usually do arise from repeated contacts over time (6). Reported benefits include a better patient-doctor relationship (7,8), better preventive care (9), fewer emergency department visits (10), greater patient and doctor satisfaction (8,11,12), fewer hospital admissions (13), reduced health care costs (14), better medication compliance and prescription (9,(15)(16)(17)(18)(19) and reduced mortality rates (20,21). Adverse effects of personal continuity include frustrated or difficult patient-doctor relationships and delayed diagnosis or referrals (22).…”