Can continuity of care in primary care be sustained in the modern health system?

Wright, Michael; Mainous, Arch G.

doi:10.31128/ajgp-06-18-4618

Cited by 25 publications

(26 citation statements)

References 11 publications

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“…There are three principle possible explanations. First, it may be related to poor access to care, whereby patients with multiple chronic conditions are getting treatment for their conditions (perhaps from a pharmacy) but there is a lack of access to care from the primary care system [54][55][56][57]. It could also relate to cost, such as a lack of comprehensive universal coverage fee at the point of care [36,[58][59][60].…”

Section: Clinical and Policy Implicationsmentioning

confidence: 99%

“…In reality, the problem may be a combination of these three possibilities. Primary healthcare clinicians need to improve the follow up on patients, in order to assess possible discontinuation of certain treatments due to adverse drug events, and the financial constraints that limit patients' ability to go for follow up check-ups and refilling prescriptions [36,56,57]. Another clinical implication is on prioritising NCDs, whereby clinicians should assess NCD profiles of patients, prioritise treatment for patients who would have the greatest clinical benefit of better management and control, and consider personal preferences of patients for managing various NCDs [6,[66][67][68].…”

Section: Clinical and Policy Implicationsmentioning

confidence: 99%

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Patients with more comorbidities have better detection of chronic conditions, but poorer management and control: findings from six middle-income countries

et al. 2020

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Background: The burden of non-communicable diseases (NCDs) is rising rapidly in middle-income countries (MICs), where NCDs are often undiagnosed, untreated and uncontrolled. How comorbidity impacts diagnosis, treatment, and control of NCDs is an emerging area of research inquiry and have important clinical implications as highlighted in the recent National Institute for Health and Care Excellence guidelines for treating patients suffering from multiple NCDs. This is the first study to examine the association between increasing numbers of comorbidities with being undiagnosed, untreated, and uncontrolled for NCDs, in 6 large MICs. Methods: Cross-sectional analysis of the World Health Organisation Study of Global Ageing and Adult Health (WHO SAGE) Wave 1 (2007-10), which consisted of adults aged ≥18 years from 6 populous MICs, including China, Ghana, India, Mexico, Russia and South Africa (overall n = 41, 557). Results: A higher number of comorbidities was associated with better odds of diagnosis for hypertension, angina, and arthritis, and higher odds of having treatment for hypertension and angina. However, more comorbidities were associated with increased odds of uncontrolled hypertension, angina, arthritis, and asthma. Comorbidity with concordant conditions was associated with improved diagnosis and treatment of hypertension and angina. Conclusion: Patients with more comorbidities have better diagnosis of chronic conditions, but this does not translate into better management and control of these conditions. Patients with multiple NCDs are high users of health services and are at an increased risk of adverse health outcomes. Hence, improving their access to care is a priority for healthcare systems.

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Section: Clinical and Policy Implicationsmentioning

confidence: 99%

Section: Clinical and Policy Implicationsmentioning

confidence: 99%

Patients with more comorbidities have better detection of chronic conditions, but poorer management and control: findings from six middle-income countries

et al. 2020

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“…4,5,17,44 Healthcare systems in LMICs like China may need to implement policies that improve access to care from the primary care system for continual treatment after rst diagnosis. [48][49][50][51] Policies that prioritise NCD combinations that include mental health conditions that are more prevalent or associated with poorer management and control need be considered, such as reducing costs of medicines and clinic visits. 35,52 It is worth noting that health-care delivery in China is hospital-centered and fragmented, with little coordination among health-care providers across different tiers of the system 53 .…”

Section: Comparison With Literaturementioning

confidence: 99%

The Associations Between Mental Disorders and Cascade of Care in Managing Hypertension, Diabetes, Dyslipidemia, Chronic Kidney Disease in China: A Pooled Cross-Sectional Analysis

Zhang¹,

Sum²,

Qin³

et al. 2020

Preprint

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Physical non-communicable diseases (NCDs) and mental disorder are a rapidly increasing health burden in low-and middle-income countries. This study aims to examine the relationships between mental disorder and cascade of care in managing four common physical NCDs (hypertension, diabetes, dyslipidemia, chronic kidney disease) in China. We utilized two waves of nationally-representative China Health and Retirement Longitudinal Study (CHARLS 2011, 2015) of older adult population aged 45 and above. A series of multivariate mixed-effect logistic regression was applied to evaluate the association between presence of mental disorder and physical chronic disease awareness, treatment, and control. We found that the odds of dyslipidemia (AOR=2.88, 95% CI=2.21-3.74) and kidney disease awareness (AOR=4.14, 95% CI=2.95-5.81) were higher for individuals with mental chronic conditions, compared to those without mental chronic conditions. The odds of having hypertension treatment was higher for subjects with mental disorder, compared to those without (AOR=1.57, 95% CI=1.23-2.01). The odds of having physical chronic conditions controlled was not significantly associated with having mental chronic conditions. These results indicated that adults with mental disorder have a greater likelihood of awareness of having dyslipidemia and kidney disease, and receiving treatment for hypertension. Strategies to address growing burden of physical-mental NCDs in China should include efforts to improve management of patients with comorbid health condition and improve access to continual high-quality treatment after the first diagnosis.

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“…A recent systematic review of continuity of care demonstrated that it is associated with lower mortality rates, perhaps via some of the mechanisms mentioned above. There is a strong perception that the current health system, which includes many part‐time doctors, discourages continuity, although part‐timers may actually be preferred by patients in some cases . An acknowledgement of the importance of continuity through the system (eg, by patient identification of their own GP and potentially voluntary enrolment with a regular GP) might benefit patients and overall health expenditure.…”

Section: Coordination and Continuity Of Carementioning

confidence: 99%

Improving the delivery of primary care for older people

Pond

Regan

2019

Medical Journal of Australia

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Can continuity of care in primary care be sustained in the modern health system?

Cited by 25 publications

References 11 publications

Patients with more comorbidities have better detection of chronic conditions, but poorer management and control: findings from six middle-income countries

Patients with more comorbidities have better detection of chronic conditions, but poorer management and control: findings from six middle-income countries

The Associations Between Mental Disorders and Cascade of Care in Managing Hypertension, Diabetes, Dyslipidemia, Chronic Kidney Disease in China: A Pooled Cross-Sectional Analysis

Improving the delivery of primary care for older people

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