Team-based continuity of care for patients with hypertension: a retrospective primary care cohort study in Hong Kong

Abstract

Background: Continuity of care (COC) is associated with improved health outcomes in hypertension patients. Team-based COC allows more flexibility in service delivery but there is a lack of research on its effectiveness for hypertension patients. Aim: This study aimed to investigate the effectiveness of team-based COC on cardiovascular disease prevention in patients with hypertension. Design and setting: A retrospective cohort study in primary care setting. Methods: 421,640 patients visiting public primary care clinics in Hong Kong from 2008 to 2018 were included in the study. The usual provider continuity index (UPCI) was used to measure the COC provided by the most visited physician team. Cox regression and restricted cubic splines (RCS) were applied to model the association between the COC and the risk for CVDs and all-cause mortality. Results: Compared to participants in the lowest quartile of UPCI, the hazard ratio for overall CVD was 0.94 (0.92,0.96), 0.91 (0.89,0.93), and 0.90 (0.88,0.92) in the 2nd, 3rd and 4th quartile, respectively. A greater effect size on CVD risk reduction was observed among the patients with unsatisfactory blood pressure control, the patients<65 years old and those with a Charlson Comorbidity Index<4 at baseline (Pinteraction<0.05), but the effect was insignificant among the participants with an estimated glomerular filtration rate of <60ml/min/1.73m2 at baseline. Conclusions: Team-based COC via a coordinated physician team was associated with reduced risks of CVD and all-cause mortality among hypertension patients, especially for the patients with unsatisfactory blood pressure control. Early initiation of team-based COC may also achieve extra benefits.

The Relationship Between Continuity of Care and Enhancement of Clinical Outcomes Among Patients with Chronic Conditions

“…A few studies in the literature have highlighted the impact of having personal providers for BP control. A retrospective study conducted by Wanchun Xu et al 25 in Hong Kong not only suggested a link between continuity of care and reduced cardiovascular disease risk but also indicated an overall decline in the mortality rate associated with hypertension. Moreover, a study in Colombia underscored the correlation between continuity of care and effective BP control within primary care services.…”

Continuity and breaches in GP care and their associations with mortality for patients with chronic disease: an observational study using Norwegian registry data

“…Research claims that patients with chronic diseases benefit from all types of CoC, 18 – 22 although evidence is limited on whether patients benefit from disease-related or overall CoC. In a previous study on patients with asthma, chronic obstructive pulmonary disease (COPD), diabetes mellitus, and heart failure, this author group demonstrated lower mortality associated with higher chronic care continuity in the overall healthcare system.…”