Patients in the highest quartile of team-based continuity of care had a 10% lower risk of overall cardiovascular disease compared to those in the lowest quartile (HR 0.90).
Cohort (n=421,640)
Yes
Does higher team-based continuity of care reduce cardiovascular disease and mortality in patients with hypertension?
Higher team-based continuity of care is associated with a reduced risk of cardiovascular disease and all-cause mortality in patients with hypertension, particularly those with poorly controlled blood pressure.
Hazard Ratio: 0.9 (95% CI 0.88–0.92)
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 ( P interaction<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 m 2 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.
Xu et al. (Fri,) conducted a cohort in Hypertension (n=421,640). Team-based continuity of care (highest quartile of UPCI) vs. Lowest quartile of team-based continuity of care (UPCI <0.50) was evaluated on Overall cardiovascular disease (CVD) events (HR 0.90, 95% CI 0.88-0.92). Patients in the highest quartile of team-based continuity of care had a 10% lower risk of overall cardiovascular disease compared to those in the lowest quartile (HR 0.90).