The intersection of patient complexity, prescriber continuity and acute care utilization

Area of Science:

• Health Services Research
• Medication Management
• Patient Care Coordination

Background:

• Care continuity is vital for high-performing health systems.
• Medication management continuity for complex patients with multiple providers is understudied.

Purpose of the Study:

• To identify patient factors linked to a higher number of prescribers.
• To examine the association between prescriber count and acute care utilization.

Main Methods:

• Retrospective cohort study of 7,933 Veterans with cardiometabolic conditions in 2008.
• Poisson regression modeled associations between conditions, prescribers, and acute care use (inpatient admissions, ER visits).
• Covariates included demographics, medication count, and comorbidities.

Main Results:

• More cardiometabolic conditions were associated with more prescribers (p < 0.001).
• Increased prescribers correlated with higher odds of ER visits (ORs 1.16-1.39) and inpatient admissions (ORs 1.27-1.34).
• Acute care utilization was not significantly associated with the number of conditions.

Conclusions:

• Higher prescriber numbers are linked to increased healthcare utilization in complex patients.
• The number of prescribers, not conditions, is a key factor in acute care use.
• Reducing prescriber numbers may be a strategy to decrease acute care utilization.