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Hou Y, Trogdon JG, Freburger JK, Bushnell CD, Halladay JR, Duncan PW, Kucharska-Newton AM. Association of Continuity of Care With Health Care Utilization and Expenditures Among Patients Discharged Home After Stroke or Transient Ischemic Attack. Med Care 2024; 62:270-276. [PMID: 38447009 DOI: 10.1097/mlr.0000000000001983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
OBJECTIVES To examine the association of prestroke continuity of care (COC) with postdischarge health care utilization and expenditures. STUDY POPULATION The study population included 2233 patients with a diagnosis of stroke or a transient ischemic attack hospitalized in one of 41 hospitals in North Carolina between March 2016 and July 2019 and discharged directly home from acute care. METHODS COC was assessed from linked Centers for Medicare and Medicaid Services Medicare claims using the Modified, Modified Continuity Index. Logistic regressions and 2-part models were used to examine the association of prestroke primary care COC with postdischarge health care utilization and expenditures. RESULTS Relative to patients in the first (lowest) COC quartile, patients in the second and third COC quartiles were more likely [21% (95% CI: 8.5%, 33.5%) and 33% (95% CI: 20.5%, 46.1%), respectively] to have an ambulatory care visit within 14 days. Patients in the highest COC quartile were more likely to visit a primary care provider but less likely to see a stroke specialist. Highest as compared with lowest primary care COC quartile was associated with $45 lower (95% CI: $14, $76) average expenditure for ambulatory care visits within 30 days postdischarge. Patients in the highest, as compared with the lowest, primary care COC quartile were 36% less likely (95% CI: 8%, 64%) to be readmitted within 30 days postdischarge and spent $340 less (95% CI: $2, $678) on unplanned readmissions. CONCLUSIONS These findings underscore the importance of primary care COC received before stroke hospitalization to postdischarge care and expenditures.
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Affiliation(s)
- Yucheng Hou
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
| | - Justin G Trogdon
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Janet K Freburger
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Cheryl D Bushnell
- Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC
| | - Jacqueline R Halladay
- Department of Family Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Pamela W Duncan
- Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC
| | - Anna M Kucharska-Newton
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY
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Wang J, Tan F, Wang Z, Yu Y, Yang J, Wang Y, Shao R, Yin X. Understanding Gaps in the Hypertension and Diabetes Care Cascade: Systematic Scoping Review. JMIR Public Health Surveill 2024; 10:e51802. [PMID: 38149840 PMCID: PMC10907944 DOI: 10.2196/51802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/22/2023] [Accepted: 12/27/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Hypertension and diabetes are global health challenges requiring effective management to mitigate their considerable burden. The successful management of hypertension and diabetes requires the completion of a sequence of stages, which are collectively termed the care cascade. OBJECTIVE This scoping review aimed to describe the characteristics of studies on the hypertension and diabetes care cascade and identify potential interventions as well as factors that impact each stage of the care cascade. METHODS The method of this scoping review has been guided by the framework by Arksey and O'Malley. We systematically searched MEDLINE, Embase, and Web of Science using terms pertinent to hypertension, diabetes, and specific stages of the care cascade. Articles published after 2011 were considered, and we included all studies that described the completion of at least one stage of the care cascade of hypertension and diabetes. Study selection was independently performed by 2 paired authors. Descriptive statistics were used to elucidate key patterns and trends. Inductive content analysis was performed to generate themes regarding the barriers and facilitators for improving the care cascade in hypertension and diabetes management. RESULTS A total of 128 studies were included, with 42.2% (54/128) conducted in high-income countries. Of them, 47 (36.7%) focused on hypertension care, 63 (49.2%) focused on diabetes care, and only 18 (14.1%) reported on the care of both diseases. The majority (96/128, 75.0%) were observational in design. Cascade stages documented in the literature were awareness, screening, diagnosis, linkage to care, treatment, adherence to medication, and control. Most studies focused on the stages of treatment and control, while a relative paucity of studies examined the stages before treatment initiation (76/128, 59.4% vs 52/128, 40.6%). There was a wide spectrum of interventions aimed at enhancing the hypertension and diabetes care cascade. The analysis unveiled a multitude of individual-level and system-level factors influencing the successful completion of cascade sequences in both high-income and low- and middle-income settings. CONCLUSIONS This review offers a comprehensive understanding of hypertension and diabetes management, emphasizing the pivotal factors that impact each stage of care. Future research should focus on upstream cascade stages and context-specific interventions to optimize patient retention and care outcomes.
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Affiliation(s)
- Jie Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Fangqin Tan
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhenzhong Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yiwen Yu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jingsong Yang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yueqing Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ruitai Shao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xuejun Yin
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Trivedi R, Marschner S, Shaw T, Min H, Yue J, Kazi S, Nguyen TN, Laranjo L, Chow CK. Factors influencing blood pressure control in patients with atrial fibrillation and hypertension in Australian primary care. Heart 2023; 110:94-100. [PMID: 37474252 PMCID: PMC10803991 DOI: 10.1136/heartjnl-2023-322602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/12/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVE This study explored factors that may influence blood pressure (BP) control in patients with atrial fibrillation (AF) with hypertension. METHODS Cross-sectional retrospective analysis of the MedicineInsight database which includes de-identified electronic health records from general practices (GPs) across Australia. BP control was assessed in patients with diagnosed AF and hypertension (controlled BP defined as <140/90 mm Hg). We explored BP control, factors influencing BP control and likelihood of receiving guideline-recommended treatment. RESULTS 34 815 patients with AF and hypertension were included; mean age was 76.9 (10.2 SD) years and 46.2% were female. 38.0% had uncontrolled BP. Women (OR 0.72; 95% CI 0.68, 0.76; p<0.001) and adults ≥75 years (OR 0.78; 95% CI 0.70, 0.86; p<0.001) were less likely to have controlled BP. Greater continuity of care (CoC; that is, visits with the same clinician) and having frequent GP visits were associated with higher odds of controlled BP (model 1: CoC, OR 1.29; 95% CI 1.20, 1.40, p<0.001; GP visits, OR 1.71; 95% CI 1.58, 1.85, p<0.001) and a greater likelihood of being prescribed ≥2 types of BP-lowering medicines (model 2: CoC, OR 1.12; 95% CI 1.03, 1.23; p=0.011; GP visits, OR 1.80; 95% CI 1.63, 1.98; p<0.001). CONCLUSIONS Uncontrolled BP was more likely in women and adults ≥75 years. Patients who had frequent GP visits with the same clinician were more likely to have BP controlled and receive guideline-recommended antihypertensive treatment. This suggests that targeting these primary care factors could potentially improve BP control and subsequently reduce stroke risk in patients with AF.
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Affiliation(s)
- Ritu Trivedi
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
| | - Simone Marschner
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
| | - Tim Shaw
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Haeri Min
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
| | - Jason Yue
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
| | - Samia Kazi
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
- Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Tu Ng Nguyen
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
| | - Liliana Laranjo
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
| | - Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
- Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
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Xu W, Yu EYT, Chin WY, Mak IL, Chan CIY, Lam CLK, Wan EYF. Team-based continuity of care for patients with hypertension: a retrospective primary care cohort study in Hong Kong. Br J Gen Pract 2023; 73:e807-e815. [PMID: 37845086 PMCID: PMC10587903 DOI: 10.3399/bjgp.2023.0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/03/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Continuity of care (COC) is associated with improved health outcomes in patients with hypertension. Team-based COC allows more flexibility in service delivery but there is a lack of research on its effectiveness for patients with hypertension. AIM To investigate the effectiveness of team-based COC on the prevention of cardiovascular disease (CVD) and mortality in patients with hypertension. DESIGN AND SETTING A retrospective cohort study in a primary care setting in Hong Kong. METHOD Eligible patients included those visiting public primary care clinics in Hong Kong from 2008 to 2018. 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 were applied to model the association between the COC and the risk for CVDs and all-cause mortality. RESULTS This study included 421 640 eligible patients. Compared with participants in the lowest quartile of UPCI, the hazard ratios for overall CVD were 0.94 (95% CI = 0.92 to 0.96), 0.91(95% CI = 0.89 to 0.93), and 0.90 (95% CI = 0.88 to 0.92) in the second, third, and fourth quartiles, respectively. A greater effect size on CVD risk reduction was observed among the patients with unsatisfactory blood pressure control, patients aged <65 years, and those with a Charlson comorbidity index of <4 at baseline (Pinteraction<0.05 in these subgroup analyses), but the effect was insignificant among the participants with an estimated glomerular filtration rate of <60 ml/ min/1.73 m2 at baseline. CONCLUSION Team-based COC via a coordinated physician team was associated with reduced risks of CVD and all-cause mortality among patients with hypertension, especially for the patients with unsatisfactory blood pressure control. Early initiation of team-based COC may also achieve extra benefits.
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Affiliation(s)
- Wanchun Xu
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region (SAR)
| | - Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region (SAR)
| | - Weng Yee Chin
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region (SAR)
| | - Ivy Lynn Mak
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region (SAR)
| | - Cheyenne I Ying Chan
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region (SAR)
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR; Department of Family Medicine, University of Hong Kong, Shenzhen Hospital, Shenzhen
| | - Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, and Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR
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Austin AM, Schaefer AP, Arakelyan M, Freyleue SD, Goodman DC, Leyenaar JK. Specialties Providing Ambulatory Care and Associated Health Care Utilization and Quality for Children With Medical Complexity. Acad Pediatr 2023; 23:1542-1552. [PMID: 37468062 PMCID: PMC10792122 DOI: 10.1016/j.acap.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/30/2023] [Accepted: 07/11/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE Although children with medical complexity (CMC) have substantial health care needs, the extent to which they receive ambulatory care from primary care versus specialist clinicians is unknown. We aimed to determine the predominant specialty providing ambulatory care to CMC (primary care or specialty discipline), the extent to which specialists deliver well-child care, and associations between having a specialty predominant provider and health care utilization and quality. METHODS In a retrospective cohort analysis of 2012-17 all-payer claims data from Colorado, New Hampshire, and Massachusetts, we identified the predominant specialty providing ambulatory care for CMC <18 years. Propensity score weighting was used to create a balanced sample of CMC and assess differences in outcomes, including adequate well-child care, continuity of care, emergency visits, and hospitalizations, between CMC with a primary care versus specialty predominant provider. RESULTS Among 67,218 CMC, 75.3% (n = 50,584) received the plurality of care from a primary care discipline. Body system involvement, age > 2 years, urban residence, and cooccurring disabilities were associated with predominantly receiving care from specialists. After propensity score weighting, there were no significant differences between CMC with a primary care or specialist "predominant specialty seen" (PSS) in ambulatory visit counts, adequate well-child care, hospitalizations, or overall continuity of care. Specialists were the sole providers of well-child care and vaccines for 49.9% and 53.1% of CMC with a specialist PSS. CONCLUSIONS Most CMC received the plurality of care from primary care disciplines, and there were no substantial differences in overall utilization or quality based on the PSS.
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Affiliation(s)
- Andrea M Austin
- The Dartmouth Institute for Health Policy and Clinical Practice (AM Austin, AP Schaefer, SD Freyleue, D Goodman, and JK Leyenaar), Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Andrew P Schaefer
- The Dartmouth Institute for Health Policy and Clinical Practice (AM Austin, AP Schaefer, SD Freyleue, D Goodman, and JK Leyenaar), Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Mary Arakelyan
- Department of Pediatrics (M Arakelyan and JK Leyenaar), Dartmouth Health Children's, Lebanon, NH
| | - Seneca D Freyleue
- The Dartmouth Institute for Health Policy and Clinical Practice (AM Austin, AP Schaefer, SD Freyleue, D Goodman, and JK Leyenaar), Geisel School of Medicine at Dartmouth, Hanover, NH
| | - David C Goodman
- The Dartmouth Institute for Health Policy and Clinical Practice (AM Austin, AP Schaefer, SD Freyleue, D Goodman, and JK Leyenaar), Geisel School of Medicine at Dartmouth, Hanover, NH
| | - JoAnna K Leyenaar
- The Dartmouth Institute for Health Policy and Clinical Practice (AM Austin, AP Schaefer, SD Freyleue, D Goodman, and JK Leyenaar), Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Pediatrics (M Arakelyan and JK Leyenaar), Dartmouth Health Children's, Lebanon, NH.
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6
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Zhen J, Wang J, Wang YL, Jiao J, Li J, Du XJ, Li YL. Fear of recurrence in elderly patients with coronary heart disease: the current situation and influencing factors according to a questionnaire analysis. BMC Cardiovasc Disord 2022; 22:419. [PMID: 36131233 PMCID: PMC9494841 DOI: 10.1186/s12872-022-02853-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/26/2022] [Indexed: 11/10/2022] Open
Abstract
Objective Fear of recurrence is a common psychosocial sequela among patients with heart disease. Analyses of coronary heart disease, particularly in elderly patients, are relatively rare. This study aimed to investigate the current situation in this context, as well as the influencing fear factors concerning recurrence in elderly patients with coronary heart disease. Methods A total of 200 elderly outpatients with coronary heart disease were recruited to participate in this survey from a tertiary hospital in Baoding (China). The questionnaires included items from the Disease Progression Simplified Scale, the Simplified Coping Style Questionnaire, and the Social Support Rating Scale (SSRS). Univariate and multivariate regression analyses were adopted to investigate the influencing factors on the fear of recurrence. Results The fear of recurrence score in elderly patients with coronary heart disease was (38.46 ± 8.13), among which 119 cases (59.5%) scored higher than 34 points. The SSRS total average score was (34.89 ± 9.83) points. Positive coping style and social support were negatively correlated with the total score of recurrence fear (r = − 0.621, − 0.413, both P < 0.001). There was a positive correlation between negative coping style and the total score of recurrence fear (r = 0.232, P < 0.001). Multiple linear regression analysis showed that the course of the disease, the number of disease recurrence cases, active coping, and social support were relevant factors in fear of recurrence (all P < 0.05). Conclusion The detection rate of fear of recurrence in elderly patients with coronary heart disease was relatively high but could be reduced by active interventions and enhancing social support.
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Affiliation(s)
- Jing Zhen
- Neurosurgery Intensive Care Unit, Affiliated Hospital of Hebei University, No. 212 of Yuhua East Road, Lianchi District, Baoding, 071000, Hebei, China
| | - Jing Wang
- Inspection department, Affiliated Hospital of Hebei University, Baoding, 071000, Hebei, China
| | - Yi-Lin Wang
- School of Basic Medicine of Shandong University, Jinan, 250012, Shandong, China
| | - Jin Jiao
- Neurosurgery Intensive Care Unit, Affiliated Hospital of Hebei University, No. 212 of Yuhua East Road, Lianchi District, Baoding, 071000, Hebei, China.,Medical Oncology Department, Affiliated Hospital of Hebei University, Baoding, China
| | - Jing Li
- Neurosurgery Intensive Care Unit, Affiliated Hospital of Hebei University, No. 212 of Yuhua East Road, Lianchi District, Baoding, 071000, Hebei, China.,Cardiovascular Department, Affiliated Hospital of Hebei University, Baoding, China
| | - Xiao-Jing Du
- School of Basic Medicine of Shandong University, Jinan, 250012, Shandong, China.,School of Nursing, He Bei University, Baoding, China
| | - Yan-Ling Li
- Department of Tuberculosis, Affiliated Hospital of Hebei University, Baoding, China.
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Tammes P, Payne RA, Salisbury C. Association between continuity of primary care and both prescribing and adherence of common cardiovascular medications: a cohort study among patients in England. BMJ Open 2022; 12:e063282. [PMID: 36100300 PMCID: PMC9472141 DOI: 10.1136/bmjopen-2022-063282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To investigate whether better continuity of care is associated with increased prescribing of clinically relevant medication and improved medication adherence. SETTING Random sample of 300 000 patients aged 30+ in 2017 within 83 English general practitioner (GP) practices from the Clinical Practice Research Datalink. DESIGN 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. PARTICIPANTS 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. MAIN OUTCOME MEASURES (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. RESULTS 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). CONCLUSION 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.
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Affiliation(s)
- Peter Tammes
- Centre for Academic Primary Care (CAPC), Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Rupert A Payne
- Centre for Academic Primary Care (CAPC), Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Chris Salisbury
- Centre for Academic Primary Care (CAPC), Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
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Kim SH, Kim H, Jeong SH, Jang SY, Park EC. Impact of continuity of care on risk for major osteoporotic fracture in patients with new onset rheumatoid arthritis. Sci Rep 2022; 12:10189. [PMID: 35715560 PMCID: PMC9205920 DOI: 10.1038/s41598-022-14368-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 05/17/2022] [Indexed: 11/24/2022] Open
Abstract
There is a clear relationship between rheumatoid arthritis (RA) and major osteoporotic fracture (MOF), although there is limited evidence on the effect of continuity of care (COC) on MOF in these patients. We investigated the association between COC and risk of MOF, including fractures of the lumbar spine and pelvis, forearm, and hip, among newly diagnosed RA patients aged ≥ 60 years. A total of 8715 incident RA patients from 2004 to 2010 were included from the Korean National Health Insurance Service-Senior cohort database. Participants were categorized into a good and bad COC group according to the COC index. The cumulative incidence of MOF was higher in RA patients with bad than in those with good COC (p < 0.001). The incidence rates of MOF were 4439 and 3275 cases per 100,000 person-years in patients with bad and good COC, respectively. RA patients with bad COC had an increased incidence of overall MOF (adjusted hazard ratio, 1.32; 95% confidence interval, 1.14–1.53), with the highest increase in risk being that of forearm fracture. An increased MOF risk in patients with bad COC was predominantly observed in females. This study suggested that interventions that can improve COC in patients with RA should be considered.
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Affiliation(s)
- Seung Hoon Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.,Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.,Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Hyunkyu Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.,Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.,Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Hoon Jeong
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.,Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Suk-Yong Jang
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.,Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | - Eun-Cheol Park
- Department of Preventive Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea. .,Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.
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Gala P, Sriram V, Kotian C, Ballala K, Vedanthan R, Perish E, Umakanth S, Meltzer D. Perceptions of the Doctor-Patient Relationship Among Patients in a Private, Secondary-Level Hospital in Southern India. Front Public Health 2022; 9:768705. [PMID: 35463195 PMCID: PMC9019150 DOI: 10.3389/fpubh.2021.768705] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/22/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction An epidemic of non-communicable diseases (NCDs) in India is fueling a growing demand for primary care and hospitalization services. Difficulties in coordinating inpatient and outpatient care create significant barriers to providing high-quality medical care. In this paper, we describe patient experiences, perceptions, and expectations of doctor-patient relationships in a secondary-level private hospital in Karnataka, India. Methods We conducted a cross-sectional, mixed-method needs assessment with surveys and in-depth interviews at Dr. TMA Pai Hospital (TMAPH), a secondary-level, private sector hospital in Karnataka, India. Inclusion criteria included all adults over 18 years old hospitalized at TMAPH in the past year. Patients were consecutively recruited from August 2019-October 2019 and asked to rate aspects of their relationship with their primary care provider (PCP). Descriptive statistics and multivariable logistic regression were used to analyze predictors of the doctor-patient relationship. Patients were interviewed regarding their perceptions of care coordination and doctor-patient relationships. General Thematic Analysis was utilized to analyze qualitative data and develop themes. Quantitative and qualitative findings were then merged to interpret the various dimensions of doctor-patient relationships. Results A total of 150 patients (47.3% male) enrolled. Ten patients underwent qualitative interviews. The median patient age was 67 years (IQR 56-76). 112 (74.7%) of patients identified a PCP either at or outside of TMAPH. 89% had diabetes and/or hypertension. Compared to patients without a PCP, having a PCP led to a significantly higher adjusted odds of always spending optimal time with their doctors (aOR 2.7, 95% CI 1.1-6.8, p = 0.04), and always receiving clear instructions on managing their medical conditions (aOR 2.5, 95% CI 1.0-6.1, p = 0.04). The following themes were developed from patient interviews: (1) patients trusted and respected their PCP believing they were receiving high quality care; and (2) despite perceived fragmentation in care, patients spoke favorably of their relationships with their doctors. Conclusions Among a sample of recently hospitalized patients, those with a PCP reported more positive doctor-patient relationships, though rates of dissatisfaction with doctors were still high. Further research and strategies are required to optimize continuity of care and doctor-patient relationships across the entire continuum of outpatient and inpatient care.
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Affiliation(s)
- Pooja Gala
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States.,Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Veena Sriram
- School of Population and Public Health, School of Public Policy and Global Affairs, University of British Columbia, Vancouver, BC, Canada
| | - Chitra Kotian
- Department of Medicine, Dr. TMA Pai Hospital (Udupi), Melaka Manipal Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Kirthinath Ballala
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Rajesh Vedanthan
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Emily Perish
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Shashikiran Umakanth
- Department of Medicine, Dr. TMA Pai Hospital (Udupi), Melaka Manipal Medical College, Manipal Academy of Higher Education, Manipal, India
| | - David Meltzer
- Department of Medicine, University of Chicago, Chicago, IL, United States
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The Impact of COVID-19 Protocols on the Continuity of Care for Patients with Hypertension. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031735. [PMID: 35162758 PMCID: PMC8835649 DOI: 10.3390/ijerph19031735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/25/2022] [Accepted: 01/30/2022] [Indexed: 11/18/2022]
Abstract
The aim of this study was to investigate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the continuity of care (COC) for patients with hypertension. Additionally, the factor of whether participants were treated via telemedicine was also considered. This study used the National Health Insurance and Medical Aid claims data of the Republic of Korea between 2019 and 2020. Multivariable regression analysis was performed to identify the differences in the number of visits and the most frequent provider continuity (MFPC) of hypertensive patients before and after the appearance of COVID-19 in Korea. Additional analysis was performed with data that excluded cases of patients who received telemedicine services. A total of 5,791,812 hypertensive patients were included in this study. The MFPC decreased by 0.0031 points after the appearance of COVID-19, and it showed the same decrease even when telemedicine cases were excluded. The number of outpatient clinic visit days decreased by 0.2930 days after the appearance of COVID-19. Without the telemedicine cases, the number of outpatient clinic visit days decreased by 0.3330 days after the appearance of COVID-19. Accordingly, the COVID-19 protocols did not affect hypertension patients’ COC but impacted the frequency of their outpatient visits. In other words, with or without telemedicine, the utilization of healthcare was not disrupted, but there was a significant difference in the volume of healthcare use depending on the inclusion of telemedicine cases.
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Choi D, Chen Q, Goonewardena SN, Pacheco H, Mejia P, Smith RL, Rosenson RS. Efficacy of Statin Therapy in Patients with Hospital Admission for COVID-19. Cardiovasc Drugs Ther 2021; 36:1165-1173. [PMID: 34524566 PMCID: PMC8440735 DOI: 10.1007/s10557-021-07263-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE COVID-19 is characterized by dysfunctional immune responses and metabolic derangements, which in some, lead to multi-organ failure and death. Statins are foundational lipid-lowering therapeutics for cardiovascular disease and also possess beneficial immune-modulating properties. Because of these immune-modulating properties, some have suggested their use in COVID-19. We sought to investigate the association between statin use and mortality in patients hospitalized with COVID-19. METHODS Five thousand three hundred seventy-five COVID-19 patients admitted to Mount Sinai Health System hospitals in New York between February 27, 2020, and December 3, 2020, were included in this analysis. Statin use was classified as either non-user, low-to-moderate-intensity user, or high-intensity user. Multivariate Cox proportional hazards models were used to evaluate in-hospital mortality rate. Considered covariates were age, sex, race, and comorbidities. RESULTS Compared to non-statin users, both low-to-moderate-intensity (adjusted hazard ratio; aHR 0.62, 95% confidential intervals; CI 0.51-0.76) and high-intensity statin users (aHR 0.53, 95% CI 0.43-0.65) had a reduced risk of death. Subgroup analysis of 723 coronary artery disease patients showed decreased mortality among high-intensity statin users compared to non-users (aHR 0.51, 95% CI 0.36-0.71). CONCLUSIONS Statin use in patients hospitalized with COVID-19 was associated with a reduced in-hospital mortality. The protective effect of statin was greater in those with coronary artery disease. These data support continued use of statin therapy in hospitalized patients with COVID-19. Clinical trials are needed to prospectively determine if statin use is effective in lowering the mortality in COVID-19 and other viral infections.
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Affiliation(s)
- Daein Choi
- Department of Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Qinzhong Chen
- Metabolism and Lipids Unit, Cardiovascular Institute, Marie-Josee and Henry R Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, The Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1030, New York, NY, 10029, USA
| | - Sascha N Goonewardena
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Hannah Pacheco
- Metabolism and Lipids Unit, Cardiovascular Institute, Marie-Josee and Henry R Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, The Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1030, New York, NY, 10029, USA
| | - Priscilla Mejia
- Metabolism and Lipids Unit, Cardiovascular Institute, Marie-Josee and Henry R Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, The Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1030, New York, NY, 10029, USA
| | - Robin L Smith
- Clinical Associate Professor, Department of Medicine, Rutgers New Jersey Medical School and the CURA Foundation, New York, NY, USA
| | - Robert S Rosenson
- Metabolism and Lipids Unit, Cardiovascular Institute, Marie-Josee and Henry R Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, The Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1030, New York, NY, 10029, USA.
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12
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Chan KS, Wan EYF, Chin WY, Cheng WHG, Ho MK, Yu EYT, Lam CLK. Effects of continuity of care on health outcomes among patients with diabetes mellitus and/or hypertension: a systematic review. BMC FAMILY PRACTICE 2021; 22:145. [PMID: 34217212 PMCID: PMC8254900 DOI: 10.1186/s12875-021-01493-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 06/17/2021] [Indexed: 02/07/2023]
Abstract
Background The rising prevalence of non-communicable diseases (NCDs) such as diabetes mellitus (DM) and hypertension (HT) has placed a tremendous burden on healthcare systems around the world, resulting in a call for more effective service delivery models. Better continuity of care (CoC) has been associated with improved health outcomes. This review examines the association between CoC and health outcomes in patients with DM and/or HT. Methods This was a systematic review with searches carried out on 13 March 2021 through PubMed, Embase, MEDLINE and CINAHL plus, clinical trials registry and bibliography reviews. Eligibility criteria were: published in English; from 2000 onwards; included adult DM and/or HT patients; examined CoC as their main intervention/exposure; and utilised quantifiable outcome measures (categorised into health indicators and service utilisation). The study quality was evaluated with Critical Appraisal Skills Programme (CASP) appraisal checklists. Results Initial searching yielded 21,090 results with 42 studies meeting the inclusion criteria. High CoC was associated with reduced hospitalisation (16 out of 18 studies), emergency room attendances (eight out of eight), mortality rate (six out of seven), disease-related complications (seven out of seven), and healthcare expenses (four out of four) but not with blood pressure (two out of 13), lipid profile (one out of six), body mass index (zero out of three). Six out of 12 studies on diabetic outcomes reported significant improvement in haemoglobin A1c by higher CoC. Variations in the classification of continuity of care and outcome definition were identified, making meta-analyses inappropriate. CASP evaluation rated most studies fair in quality, but found insufficient adjustment on confounders, selection bias and short follow-up period were common limitations of current literatures. Conclusion There is evidence of a strong association between higher continuity of care and reduced mortality rate, complication risks and health service utilisation among DM and/or HT patients but little to no improvement in various health indicators. Significant methodological heterogeneity in how CoC and patient outcomes are assessed limits the ability for meta-analysis of findings. Further studies comprising sufficient confounding adjustment and standardised definitions are needed to provide stronger evidence of the benefits of CoC on patients with DM and/or HT. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01493-x.
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Affiliation(s)
- Kam-Suen Chan
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China
| | - Eric Yuk-Fai Wan
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China. .,Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China.
| | - Weng-Yee Chin
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China
| | - Will Ho-Gi Cheng
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China
| | - Margaret Kay Ho
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China
| | - Esther Yee-Tak Yu
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China
| | - Cindy Lo-Kuen Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China
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