Effects of Continuity of Care on Medication Duplication Among the Elderly

ArticleinMedical care 52(2) · December 2013with14 Reads
DOI: 10.1097/MLR.0000000000000042 · Source: PubMed
Abstract
The effects of continuity of care on health care outcomes are well documented. However, little is known about the effect of continuity at the physician or the site level on the process of care for patients with multiple chronic conditions (MCCs). The objective of this study was to examine the effects of physician continuity versus site continuity on duplicated medications received by patients with and without MCCs. This study utilized a longitudinal design with an 8-year follow-up from 2004 to 2011 of patients aged 65 or older under a universal health insurance program in Taiwan (55,573 subjects and 389,011 subject-years). Generalized estimating equation models with propensity score method were conducted to assess the association between continuity and medication duplication. The rates of subjects receiving duplicated medications ranged from 40.38% to 43.50% with 1.45-1.62 duplicated medications during the study period. The findings revealed that better continuity, either at the physician level or the site level, was significantly associated with fewer duplicated medications. This study also indicated that the physician continuity had a stronger effect on medication duplication than did site continuity. Furthermore, the magnitude of the protective effect of continuity against duplicated medications increased when the patients had more chronic conditions [physician continuity: the marginal effect ranged from -10.7% to -52.9% (all P<0.001); site continuity: the marginal effect ranged from -0.4% (P=0.063) to -31.4% (P<0.001)]. Improving either physician continuity or site continuity may result in fewer duplicated medications, particularly for patients with MCCs.
    • "This study population had a higher continuity of care compared with other studies, since the mean COC index (0.44) was higher that the values of 0.31 reported in an observational retrospective cohort group of patients older than 65 years in the United States [30] and of 0.37– 0.39 in a follow-up study in Taiwan in patients who were first diagnosed with type 2 diabetes [16]. Moreover, this research is in line with those of some previous other studies worldwide with a value of 0.49 that has been observed in a follow-up study in Taiwan in patients at the site level [22] and in patients receiving long-term frequent care in Norway [31], 0.5 and 0.55 in the United States in sample of Medicare beneficiaries experiencing a 12-month episode of care respectively for type 2 diabetes mellitus and for congestive heart failure [12]. By contrast, the value of the Continuity of Care Index here is lower than those observed in the United States in a retrospective cohort study among seniors with 3 or more chronic conditions with a mean value of 0.6 [23] , in Korea among elderly people where the mean value was 0.735 for hypertension , 0.709 for diabetes mellitus, 0.7 for chronic obstructive pulmonary disease, 0.663 for asthma [32], and 0.752 for an adult study population with type 2 diabetes [33], and 0.74–0.76 "
    [Show abstract] [Hide abstract] ABSTRACT: The aims of the present study were to evaluate the extent of continuity of care and to investigate its association with several factors among a sample of outpatients with chronic diseases in Italy. The survey was conducted, using face to face interview, from March to December 2014 in a random sample of 633 outpatients with chronic conditions who were going in cardiology, metabolic disorders, and respiratory ambulatory center of four hospitals. A multivariate ordered logistic regression model was used to identify factors associated with the outpatients continuity of care. The mean of the Bice-Boxerman continuity of care (COC) index related to the entire sample was 0.44, and 27.9%, 58.4%, 13.7% had a low, intermediate, and high value of the index based on the tertiles of the distribution. The results of the ordered logistic regression analysis showed that female patients, those older, those who had a lower score of Katz Index of independence in activities of daily living, those who had a lower Charlson et al. comorbidity score, and those who had no hospitalization in the last year, were significantly more likely to have a higher value of the COC index. Patients who had completed a secondary school education had significantly lower odds of having a high value of COC index in comparison to patients with a college degree educational level. Policy makers and clinicians involved in the care of patients should implement comprehensively and efficiently efforts in order to improve the continuity of care in patients with chronic diseases.
    Full-text · Article · May 2016
    • "Na een Clinical Geriatric Assessment (CGA) werd dit percentage 22,3%. Overbehandeling NL: [16] INT:57585960 26,2% van 340 60-plussers (die allen chronisch 5 of meer geneesmiddelen gebruikten) werd na ontslag uit het ziekenhuis geconstateerd dat zij onnodig lang met een geneesmiddel werden behandeld. Over-of onderdosering NL: [16] INT: - Bij 14,4% van 340 60-plussers (die allen chronisch 5 of meer geneesmiddelen gebruikten) was na ontslag uit het ziekenhuis sprake van over-of onderdosering. "
    [Show abstract] [Hide abstract] ABSTRACT: Problems related to medication use by frail elderly patients Many frail elderly patients take five or more different medicines on a daily basis (polypharmacy) and make frequent hospital visits. Hospital admissions and discharges can lead to medication-related problems, ranging from unsuitable medication to harmful interactions and undertreatment or overtreatment. The most risky moments are acute hospital admissions, visits to outpatient clinics and the first few weeks after patients are discharged from hospital. These are some of the findings of a literature study and interviews with experts conducted by the Dutch National Institute for Public Health and the Environment (RIVM). Various causes Problems may arise due to the lack of up-to-date medication overviews during acute hospital admissions and visits to outpatient clinics. In addition, there is often not enough time to find out which medications are actually used by the patient. During acute admissions, frail elderly patients are not always able to inform the doctor of their medication use. After being discharged from hospital, patients do not always remember that their medication has been changed or discontinued or that they have been prescribed new medication, nor do they always understand the reasons why this has been done. Moreover, on some occasions information on discharge medication is slow to reach the general practitioner or pharmacist. Because of these issues, patients may use their medication incorrectly at home, resulting in medication-related problems without healthcare professionals being aware of it. When reconciling medication use, for example during hospital admission, healthcare professionals do check whether the medicines correspond to all available medication overviews, but they do not usually evaluate whether all the medicines used are still necessary and suitable for the patient concerned. In addition, medical specialists are often insufficiently familiar with the medication prescribed by other physicians. In some cases this can lead to the prescription of medicines that interact with each other. Also, there is no designated healthcare professional who is in charge of all medication prescribed to a patient. Matters for attention The largest benefit can probably be derived from improved digital registration and exchange of all medication-related information, including the reasons for changes made during patient treatment. In addition, patients should receive more information on any changes to their medication when they are discharged from hospital. The effects of changes in medication must be monitored during the first week after discharge. Furthermore, it is important that one healthcare professional has an overview of all medicines used, and that all medication is continuously monitored and periodically reviewed.
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  • [Show abstract] [Hide abstract] ABSTRACT: Objectives: To understand changes in the medication duplication rate after implementation of a prescribing alert system as a new criterion for hospital accreditation.
    Article · Oct 2014
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