Personal Continuity and Appropriate Prescribing in Primary Care

Area of Science:

• Primary Care Medicine
• Geriatric Pharmacology
• Health Services Research

Background:

• Personal continuity between patients and physicians is a cornerstone of primary care.
• Existing evidence linking continuity to prescribing quality, particularly potentially inappropriate prescriptions (PIPs), in primary care is limited.

Purpose of the Study:

• To investigate the association between personal continuity and PIPs, including potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs), among older patients in primary care.

Main Methods:

• An observational cohort study utilized routine data from 25,854 patients aged 65+ across 48 Dutch family practices (2013-2018).
• Personal continuity was measured using the usual provider of care, Bice-Boxerman Index, and Herfindahl Index.
• PIPs were identified using the STOPP/START criteria (Netherlands version 2), with associations analyzed via multilevel negative binomial regression.

Main Results:

• The prevalence of at least one PIM and PPO was high (72.2% and 74.3%, respectively).
• Higher levels of personal continuity, across all three measures, were significantly associated with a reduction in PIPs.
• Specifically, increased continuity correlated with fewer PIMs and PPOs.

Conclusions:

• Enhanced personal continuity in primary care is demonstrably linked to more appropriate prescribing practices for older adults.
• Strengthening the patient-physician relationship may be a key strategy to improve prescription quality and mitigate adverse drug events.