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. 2023 Oct 26;73(736):e807-e815.
doi: 10.3399/BJGP.2023.0150. Print 2023 Nov.

Team-based continuity of care for patients with hypertension: a retrospective primary care cohort study in Hong Kong

Wanchun Xu  1 , Esther Yee Tak Yu  1 , Weng Yee Chin  1 , Ivy Lynn Mak  1 , Cheyenne I Ying Chan  1 , Cindy Lo Kuen Lam  2 , Eric Yuk Fai Wan  3
Affiliations

Team-based continuity of care for patients with hypertension: a retrospective primary care cohort study in Hong Kong

Wanchun Xu et al. Br J Gen Pract. .

Abstract

Background: Continuity of care (COC) is associated with improved health outcomes in patients with hypertension. Team-based COC allows more flexibility in service delivery but there is a lack of research on its effectiveness for patients with hypertension.

Aim: To investigate the effectiveness of team-based COC on the prevention of cardiovascular disease (CVD) and mortality in patients with hypertension.

Design and setting: A retrospective cohort study in a primary care setting in Hong Kong.

Method: Eligible patients included those visiting public primary care clinics in Hong Kong from 2008 to 2018. The usual provider continuity index (UPCI) was used to measure the COC provided by the most visited physician team. Cox regression and restricted cubic splines were applied to model the association between the COC and the risk for CVDs and all-cause mortality.

Results: This study included 421 640 eligible patients. Compared with participants in the lowest quartile of UPCI, the hazard ratios for overall CVD were 0.94 (95% CI = 0.92 to 0.96), 0.91(95% CI = 0.89 to 0.93), and 0.90 (95% CI = 0.88 to 0.92) in the second, third, and fourth quartiles, respectively. A greater effect size on CVD risk reduction was observed among the patients with unsatisfactory blood pressure control, patients aged <65 years, and those with a Charlson comorbidity index of <4 at baseline (Pinteraction<0.05 in these subgroup analyses), but the effect was insignificant among the participants with an estimated glomerular filtration rate of <60 ml/ min/1.73 m2 at baseline.

Conclusion: Team-based COC via a coordinated physician team was associated with reduced risks of CVD and all-cause mortality among patients with hypertension, especially for the patients with unsatisfactory blood pressure control. Early initiation of team-based COC may also achieve extra benefits.

Keywords: cardiovascular diseases; continuity of patient care; hypertension; primary health care.

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Conflict of interest statement

Eric Yuk Fai Wan has received research grants from the Food and Health Bureau of the Government of the Hong Kong SAR and the Hong Kong Research Grant Council, outside the submitted work. Esther Yee Tak Yu has received research grants from the Food and Health Bureau of the Government of the Hong Kong SAR, outside the submitted work. Cindy Lo Kuen Lam has received research grants from the Health Bureau of the Government of the Hong Kong SAR, the Hong Kong Research Grant Council, the Hong Kong College of Family Physicians, and Kerry Group Kuok Foundation outside the submitted work.

Figures

Figure 1.
Figure 1.
Flowchart of study design. Team-based usual provider continuity index (UPCI) was calculated by dividing the number of attendances at the most visited physician team by the total number of attendances within the 2-year measurement period. Patients with <3 visits within the measurement period were excluded from the analysis to assure the accurate measurement of the UPCI. CVD = cardiovascular disease.
Figure 2.
Figure 2.
Association of team-based continuity of care with risks of CVD and all-cause mortality among patients with hypertension. Participants were classified into four groups based on UPCI quartiles. Hazard ratios were adjusted for age, sex, smoking status, systolic and diastolic blood pressure, body mass index, fasting glucose, low-density lipoprotein cholesterol, estimated glomerular filtration rate, Charlson comorbidity index, number of medical attendances, use of antihypertensive drugs, use of lipid-lowering drugs, and use of antidiabetic drugs at baseline. CVD includes coronary heart disease, heart failure, and stroke. CVD = cardiovascular disease. HR = hazards ratio. UPCI = usual provider of care index.
Figure 3.
Figure 3.
Restricted cubic splines on the association between the usual provider of care index (UPCI) and the risks of cardiovascular diseases or mortality. Analysis was adjusted for age, sex, smoking status, systolic and diastolic blood pressure, body mass index, fasting glucose, low-density lipoprotein cholesterol, estimated glomerular filtration rate, Charlson comorbidity index, number of medical attendances, use of antihypertensive drugs, use of lipid-lowering drugs, and use of antidiabetic drugs at baseline.
Figure 4.
Figure 4.
Subgroup analyses on the association between team-based continuity of care and cardiovascular diseases among patients with hypertension. Hazard ratios were adjusted by age, sex, smoking status, SBP and DBP, BMI, fasting glucose, low-density lipoprotein cholesterol, eGFR, CCI, number of attendances, use of antihypertensive drugs, use of lipid-lowering drugs, and use of antidiabetic drug at baseline. CVD includes coronary heart disease, heart failure, and stroke. BMI = body mass index. CCI = Charlson comorbidity index. CVD = cardiovascular disease. DBP = diastolic blood pressure. eGFR = estimated glomerular filtration rate. HR = hazards ratio. SBP = systolic blood pressure. UPCI = usual provider of care index.
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