Continuity of GP care for patients with dementia: impact on prescribing and the health of patients

Background Higher continuity of GP care (CGPC), that is, consulting the same doctor consistently, can improve doctor-patient relationships and increase quality of care; however, its effects on patients with dementia are mostly unknown. Aim To estimate the associations between CGPC and potentially inappropriate prescribing (PIP), and with the incidence of adverse health outcomes (AHOs) in patients with dementia. Design and setting A retrospective cohort study with 1 year of follow-up anonymised medical records from 9324 patients with dementia, aged >= 65 years living in England in 2016. Method CGPC measures include the Usual Provider of Cam (UPC). Bice Boxerman Continuity of Care (BB). and Sequential Continuity (SECON) indices. Regression models estimated associations with PIPs and survival analysis with incidence of AHOs during the follow-up adjusted for age, sex. deprivation level, 14 comorbidities, and frailty. Results The highest quartile (HO) of UPC (highest continuity) had 34.8% less risk of delirium (odds ratio [OR] 0.65, 95% confidence interval [CI] = 0.51 to 0.84), 57.9% less risk of incontinence [OR 0.42, 95% CI = 0.31 to 0.58], and 9.7% less risk of emergency admissions to hospital [OR 0.90, 95% CI - 0.82 to 0.99] compared with the lowest quartile. Potypharmacy and PIP were identified in 81.6% [n = 7612[ and 75.4% [n= 7027] of patients, respectively. The HQ had fewer prescnbed medications [HQ: mean 8.5, lowest quartile [LQ]: mean 9.7.P<0.01] and had fewer PIPs [HQ: mean 2.1, I 0: mean 2.5, P<0.01)]. including fewer loop diuretics in patients with incontinence. drugs that can cause constipation, and benzodiazepines with high fall risk. The BB and SECON measures produced similar findings. Conclusion Higher CGPC for patients with dementia was associated with safer prescribing and lower rates of major adverse events. Increasing continuity of care for patients with dementia may help improve treatment and outcomes.

Automated summary

The study found that higher continuity of GP care (CGPC) is associated with a reduced risk of potentially inappropriate prescribing (PIP) and adverse health outcomes (AHOs) in patients with dementia. Patients who consistently consult the same doctor have safer prescribing and lower rates of major adverse events.