Sylvia Robles1, Gerard F Anderson. 1. Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Baltimore, MD 21205, USA. srobles@jhsph.edu
Abstract
BACKGROUND: Continuity of care is one of the pillars of primary care; yet, it is unclear whether having a regular physician influences the use of prescription drugs among the elderly. OBJECTIVE: To assess the effect of continuity of care on prescription drug use for Medicare beneficiaries with hypertension. METHODS: Medicare beneficiaries age 67 years and older were categorized in 3 groups according to the level of continuity of care experienced during the year preceding an initial diagnosis of hypertension. The group with the lowest level (poor continuity) was selected as control, and matched on previous use of health services, sociodemographic and clinical characteristics, using propensity scores, to the intermediate and high continuity groups. Fixed effect models examined the association of continuity of care to number of drugs classes, cost of drugs, use of thiazide diuretics, and adherence to treatment. RESULTS: There was no clear evidence that Medicare beneficiaries with greater continuity of care had increased adherence to antihypertensive drugs for most variables studied. The only major difference was that total number of classes of drugs purchased was 10% higher for the intermediate group, and 15% higher for the high Continuity of Care index group compared with the control group (P<0.05). CONCLUSION: A prior history of continuity of care may lead to purchasing more drugs overall but may not increase adherence to hypertension treatment among the elderly.
BACKGROUND: Continuity of care is one of the pillars of primary care; yet, it is unclear whether having a regular physician influences the use of prescription drugs among the elderly. OBJECTIVE: To assess the effect of continuity of care on prescription drug use for Medicare beneficiaries with hypertension. METHODS: Medicare beneficiaries age 67 years and older were categorized in 3 groups according to the level of continuity of care experienced during the year preceding an initial diagnosis of hypertension. The group with the lowest level (poor continuity) was selected as control, and matched on previous use of health services, sociodemographic and clinical characteristics, using propensity scores, to the intermediate and high continuity groups. Fixed effect models examined the association of continuity of care to number of drugs classes, cost of drugs, use of thiazide diuretics, and adherence to treatment. RESULTS: There was no clear evidence that Medicare beneficiaries with greater continuity of care had increased adherence to antihypertensive drugs for most variables studied. The only major difference was that total number of classes of drugs purchased was 10% higher for the intermediate group, and 15% higher for the high Continuity of Care index group compared with the control group (P<0.05). CONCLUSION: A prior history of continuity of care may lead to purchasing more drugs overall but may not increase adherence to hypertension treatment among the elderly.
Authors: Nanette K Wenger; Caroline Lloyd Doherty; Jerry H Gurwitz; Glenn A Hirsch; Holly M Holmes; Matthew S Maurer; Michael D Murray Journal: Drugs Aging Date: 2017-11 Impact factor: 3.923