Centre for Academic Primary Care (CAPC), Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
Centre for Academic Primary Care (CAPC), Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK.
BMJ Open. 2022 Sep 13;12(9):e063282. doi: 10.1136/bmjopen-2022-063282.
To investigate whether better continuity of care is associated with increased prescribing of clinically relevant medication and improved medication adherence.
Random sample of 300 000 patients aged 30+ in 2017 within 83 English general practitioner (GP) practices from the Clinical Practice Research Datalink.
Patients were assigned to a randomly selected index date in 2017 on which medication use and continuity of care were determined. Adjusted associations between continuity of care and the prescribing and adherence of five cardiovascular medication groups were examined using logistic regression.
Continuity of Care Index was calculated for 173 993 patients with 4+ GP consultations 2 years prior to their index date and divided into five categories: absence of continuity, below-average continuity, average, above-average continuity and perfect continuity.
(A) Prescription for statins (primary or secondary prevention separately), anticoagulants, antiplatelet agents and antihypertensives covering the patient's index date. (B) Adherence (>80%) estimated using medication possession ratio.
There was strong evidence (p<0.01) that prescription of all five cardiovascular medication groups increased with greater continuity of care. Patients with absence of continuity were less likely to be prescribed cardiovascular medications than patients with above-average continuity (statins primary prevention OR 0.73, 95% CI 0.59 to 0.85; statins secondary prevention 0.77, 95% CI 0.57 to 1.03; antiplatelets 0.55, 95% CI 0.33 to 0.92; antihypertensives 0.51, 95% CI 0.39 to 0.65). Furthermore, patients with perfect continuity were more likely to be prescribed cardiovascular medications than those with above-average continuity (statins primary prevention OR 1.23, 95% CI 1.01 to 1.49; statins secondary prevention 1.37, 95% CI 1.10 to 1.71; antiplatelets 1.37, 95% CI 1.08 to 1.74; antihypertensives 1.10, 95% CI 0.99 to 1.23). Continuity was generally not associated with medication adherence, except for adherence to statins for secondary prevention (OR 0.75, 95% CI 0.60 to 0.94 for average compared with above-average continuity).
Better continuity of care is associated with improved prescribing of medication to patients at higher risk of cardiovascular disease but does not appear to be related to patient's medication adherence.
研究连续性护理的改善是否与更合理的临床相关药物开具以及改善药物依从性有关。
在 2017 年，83 家英国全科医生（GP）诊所的随机抽取的 30 万 30 岁以上患者中，对其进行了药物使用和连续性护理的研究。
患者于 2017 年被随机分配到索引日期，索引日期之前的 2 年内确定药物使用和连续性护理。使用逻辑回归分析连续性护理与五类心血管药物开具和药物依从性之间的关联。
连续性护理指数为 173993 名索引日期前 2 年内接受过 4 次以上 GP 就诊的患者计算，分为五个类别：无连续性、低于平均连续性、平均连续性、高于平均连续性和完美连续性。
（A）开具他汀类药物（分别为一级或二级预防）、抗凝剂、抗血小板药物和降压药，覆盖患者的索引日期。（B）使用药物占有率估计的药物依从性（>80%）。
有充分证据（p<0.01）表明，随着连续性护理的改善，五类心血管药物的开具均有所增加。与高于平均连续性护理的患者相比，无连续性护理的患者开具心血管药物的可能性较小（他汀类药物一级预防 OR 0.73，95%CI 0.59 至 0.85；他汀类药物二级预防 0.77，95%CI 0.57 至 1.03；抗血小板药物 0.55，95%CI 0.33 至 0.92；降压药 0.51，95%CI 0.39 至 0.65）。此外，与高于平均连续性护理的患者相比，具有完美连续性护理的患者更有可能开具心血管药物（他汀类药物一级预防 OR 1.23，95%CI 1.01 至 1.49；他汀类药物二级预防 1.37，95%CI 1.10 至 1.71；抗血小板药物 1.37，95%CI 1.08 至 1.74；降压药 1.10，95%CI 0.99 至 1.23）。连续性护理与药物依从性一般没有关联，除了二级预防的他汀类药物依从性（与高于平均连续性护理相比，平均连续性护理的 OR 为 0.75，95%CI 为 0.60 至 0.94）。
更好的连续性护理与增加开具心血管疾病高危患者药物治疗的合理性有关，但似乎与患者的药物依从性无关。
