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

Background: 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.

Objectives: 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.

Methods: 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.

Results: 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; P < .001). This was associated with further reduction in diastolic BP of 0.13 mmHg (P < .001) and LDL-C levels of 0.01 mmol/L (P = .001) per year faster than in GC, with higher proportion of patients meeting LDL-C targets (74.1% vs 68.0%; P < .001) in 2021. FPC cohort also showed greater influenza (OR = 2.88; P < .001) and pneumococcal (OR = 1.34; P < .001) vaccinations uptake. Subgroup analysis of patients with diabetes indicated better diabetic foot screening completion (OR = 1.34; P < .001). No significant improvement was found in systolic BP or cardiovascular complications.

Conclusion: Higher CoC in FPC led to clinically relevant improvement in LDL-C and vaccination, but not BP or cardiovascular complication rates.

Keywords: cardiovascular disease; continuity of care; health outcomes; hypertension; primary care.

Figure 1.

Flow diagram of the number of patients available for analysis.

Figure 2.

Boxplot of distribution of COCI score in FPC and GC cohorts. Abbreviations: COCI, Continuity of Care Index; SD, standard deviation. P-value was calculated using Mann-Whitney U test.

Figure 3.

Time series plots of trends of clinical parameters over the years in FPC and GC cohorts. A – mean systolic blood pressure. B – mean diastolic blood pressure. C – mean LDL-C level. D – mean HbA1c level. Abbreviations: CI, confidence interval; DBP, diastolic blood pressure; LDL-C, low-density lipoprotein cholesterol; SBP, systolic blood pressure.

Figure 4.

Plot of yearly Odds Ratio of vaccinations and microvascular complication screenings done in FPC cohort to GC cohort from 2015 to 2021. Error bars are 95% Confidence Interval. A – Influenza vaccination. B – Pneumococcal vaccination. C – Diabetic Foot Screening. D – Diabetic Retinal Photography.