Comparing Health Outcomes in Patients with Hypertension Receiving Continuity of Care From Regular Family Physician With Care From Multiple Physicians: A Retrospective Cohort Study.

Abstract

Effective hypertension management requires long-term lifestyle and medication adherence facilitated by regular physician. Higher continuity of care (CoC) is postulated to lead to better outcomes. This study compares health outcomes of patients with hypertension receiving CoC from single family physicians over 5-year period with those treated by multiple physicians. Retrospective cohort study was conducted using electronic medical records from multi-ethnic Asian adults with hypertension and other non-communicable diseases. Patients managed in Family Physician Clinic (FPC) across 7 Singapore public primary care polyclinics from 2015 to 2019 were propensity scores matched with those treated by multiple physicians in General Clinic (GC) of the same polyclinics. CoC Index (COCI), health outcomes including blood pressure (BP), LDL-Cholesterol (LDL-C), cardiovascular complications and preventive measures were compared until 2021. Analysis of 6520 patients (mean age 64.8 years, 56% female, 76% Chinese) showed FPC cohort had higher COCI (mean = 0.432 vs 0.073; <i>P</i> < .001). This was associated with further reduction in diastolic BP of 0.13 mmHg (<i>P</i> < .001) and LDL-C levels of 0.01 mmol/L (<i>P</i> = .001) per year faster than in GC, with higher proportion of patients meeting LDL-C targets (74.1% vs 68.0%; <i>P</i> < .001) in 2021. FPC cohort also showed greater influenza (OR = 2.88; <i>P</i> < .001) and pneumococcal (OR = 1.34; <i>P</i> < .001) vaccinations uptake. Subgroup analysis of patients with diabetes indicated better diabetic foot screening completion (OR = 1.34; <i>P</i> < .001). No significant improvement was found in systolic BP or cardiovascular complications. Higher CoC in FPC led to clinically relevant improvement in LDL-C and vaccination, but not BP or cardiovascular complication rates.