TY - JOUR
T1 - Personal Continuity and Appropriate Prescribing in Primary Care
AU - te Winkel, Marije T.
AU - Damoiseaux-Volman, Birgit A.
AU - Abu-Hanna, Ameen
AU - Lissenberg-Witte, Birgit I.
AU - van Marum, Rob J.
AU - Schers, Henk J.
AU - Slottje, Pauline
AU - Uijen, Annemarie A.
AU - Bont, Jettie
AU - Maarsingh, Otto R.
N1 - Funding Information: Key words: personal continuity; drug prescriptions; inappropriate prescribing; deprescribing; potentially inappropriate medication list; practice patterns, physicians’; family practice; primary care; geriatrics; health services for the aged; continuity of care; adverse events; polypharmacy; chronic disease Submitted May 20, 2022; submitted, revised, January 18, 2023; accepted January 24, 2023. Funding support: Marije T. te Winkel and Otto R. Maarsingh were supported by the Stichting Beroepsopleiding Huisartsen in the Netherlands. Disclaimer: The Stichting Beroepsopleiding Huisartsen was not involved in the design of the study; collection, analysis, and interpretation of the data; or writing of the manuscript. Previous presentation: Portions of the findings reported have been presented at the 50th NAPCRG Annual Meeting; November 18-22, 2022; Phoenix, Arizona. Publisher Copyright: © 2023, Annals of Family Medicine, Inc. All rights reserved.
PY - 2023/7/1
Y1 - 2023/7/1
N2 - PURPOSE Personal continuity between patient and physician is a core value of primary care. Although previous studies suggest that personal continuity is associated with fewer potentially inappropriate prescriptions, evidence on continuity and prescribing in primary care is scarce. We aimed to determine the association between personal continuity and potentially inappropriate prescriptions, which encompasses potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs), by family physicians among older patients. METHODS We conducted an observational cohort study using routine care data from patients enlisted in 48 Dutch family practices from 2013 to 2018. All 25,854 patients aged 65 years and older having at least 5 contacts with their practice in 6 years were included. We calculated personal continuity using 3 established measures: the usual provider of care measure, the Bice-Boxerman Index, and the Herfindahl Index. We used the Screening Tool of Older Person’s Prescriptions (STOPP) and the Screening Tool to Alert doctors to Right Treatment (START) specific to the Netherlands version 2 criteria to calculate the prevalence of potentially inappropriate prescriptions. To assess associations, we conducted multilevel negative binomial regression analyses, with and without adjustment for number of chronic conditions, age, and sex. RESULTS The patients’ mean (SD) values for the usual provider of care measure, the BiceBoxerman Continuity of Care Index, and the Herfindahl Index were 0.70 (0.19), 0.55 (0.24), and 0.59 (0.22), respectively. In our population, 72.2% and 74.3% of patients had at least 1 PIM and PPO, respectively; 30.9% and 34.2% had at least 3 PIMs and PPOs, respectively. All 3 measures of personal continuity were positively and significantly associated with fewer potentially inappropriate prescriptions. CONCLUSIONS A higher level of personal continuity is associated with more appropriate prescribing. Increasing personal continuity may improve the quality of prescriptions and reduce harmful consequences.
AB - PURPOSE Personal continuity between patient and physician is a core value of primary care. Although previous studies suggest that personal continuity is associated with fewer potentially inappropriate prescriptions, evidence on continuity and prescribing in primary care is scarce. We aimed to determine the association between personal continuity and potentially inappropriate prescriptions, which encompasses potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs), by family physicians among older patients. METHODS We conducted an observational cohort study using routine care data from patients enlisted in 48 Dutch family practices from 2013 to 2018. All 25,854 patients aged 65 years and older having at least 5 contacts with their practice in 6 years were included. We calculated personal continuity using 3 established measures: the usual provider of care measure, the Bice-Boxerman Index, and the Herfindahl Index. We used the Screening Tool of Older Person’s Prescriptions (STOPP) and the Screening Tool to Alert doctors to Right Treatment (START) specific to the Netherlands version 2 criteria to calculate the prevalence of potentially inappropriate prescriptions. To assess associations, we conducted multilevel negative binomial regression analyses, with and without adjustment for number of chronic conditions, age, and sex. RESULTS The patients’ mean (SD) values for the usual provider of care measure, the BiceBoxerman Continuity of Care Index, and the Herfindahl Index were 0.70 (0.19), 0.55 (0.24), and 0.59 (0.22), respectively. In our population, 72.2% and 74.3% of patients had at least 1 PIM and PPO, respectively; 30.9% and 34.2% had at least 3 PIMs and PPOs, respectively. All 3 measures of personal continuity were positively and significantly associated with fewer potentially inappropriate prescriptions. CONCLUSIONS A higher level of personal continuity is associated with more appropriate prescribing. Increasing personal continuity may improve the quality of prescriptions and reduce harmful consequences.
KW - adverse events
KW - chronic disease
KW - continuity of care
KW - deprescribing
KW - drug prescriptions
KW - family practice
KW - geriatrics
KW - health services for the aged
KW - inappropriate prescribing
KW - personal continuity
KW - polypharmacy
KW - potentially inappropriate medication list
KW - practice patterns, physicians’
KW - primary care
UR - http://www.scopus.com/inward/record.url?scp=85166090623&partnerID=8YFLogxK
U2 - https://doi.org/10.1370/afm.2994
DO - https://doi.org/10.1370/afm.2994
M3 - Article
C2 - 37487715
SN - 1544-1709
VL - 21
SP - 305
EP - 312
JO - Annals of family medicine
JF - Annals of family medicine
IS - 4
ER -