An integrated continuity of care measure improves performance in models predicting medication adherence using...

Area of Science:

• Health Services Research
• Pharmacoeconomics
• Clinical Pharmacy

Background:

• Continuity of care (COC) is crucial for medication adherence.
• Traditional measures like the usual provider continuity index (UPCI) rely solely on physician visit claims.
• The predictive value of UPCI for comprehensive physician services and its impact on adherence require further investigation.

Purpose of the Study:

• To assess if high UPCI values predict physicians providing diverse clinical services.
• To compare the predictive performance of UPCI against an integrated COC measure for statin adherence.
• To evaluate the association of different COC measures with optimal medication adherence in new statin users.

Main Methods:

• Retrospective cohort study of new statin users (2012-2017) in Saskatchewan, Canada.
• Calculated sensitivity and specificity of high UPCI for identifying physicians who prescribed statins or provided complete medical examinations.
• Used logistic regression to compare UPCI and an integrated COC measure (visits, prescribing, exams) on optimal statin adherence (proportion of days covered ≥80%).

Main Results:

• A high UPCI was not a sensitive or specific predictor of physicians prescribing statins or performing complete medical exams.
• The integrated COC measure showed a stronger association with optimal statin adherence (aOR=1.56) compared to UPCI (aOR=1.23).
• The integrated COC measure significantly improved the predictive performance of the adherence model.

Conclusions:

• Physician visit frequency alone (UPCI) is inadequate for representing continuity of care.
• An integrated measure of continuity of care enhances the prediction of optimal medication adherence in patients initiating statin therapy.
• Comprehensive assessment of continuity of care is essential for improving medication adherence outcomes.