Seeing the same GP improves care for those with dementia and reduces their risk of major adverse events, new research suggests

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It has long been recognised that continuity of care contributes to better patient–doctor relationships, and better quality of care. Indeed, lower continuity of care increases the risk of poor medication management and worse health outcomes, including increased mortality.

However, modern-day societal culture of instant gratification—getting something now—together with GPs increasingly working part-time, has driven a wedge into continuity of care in general practice. Patients appear less concerned about which doctor they see, with being seen as soon as possible, and at their greater convenience, being more important.

Sir Denis Pereira Gray, co-author of a new study and GP researcher at the St Leonard’s Practice, said: ‘Whilst national policy makers have for years discouraged continuity, general practices can still provide good GP continuity through their internal practice organisation, for example, by using personal lists.’

Inappropriate prescribing and major adverse events a risk in dementia

Research led by the University of Exeter, published in the British Journal of General Practice, has shown that for patients with dementia, continuity of care reaps many benefits.

The researchers wanted to investigate the association between continuity of GP care and potentially inappropriate prescribing, and the incidence of adverse health outcomes, in patients with dementia.

Lead author Dr João Delgado, of the University of Exeter, said: ‘The number of people with dementia has been rising steadily, and it is now one of the leading causes of death in the UK. In the absence of a cure, long-term care is particularly important. Treating people with dementia can be complex, because it often occurs together with other common diseases.’

Associate Director of Research at Alzheimer’s Society, Dr Richard Oakley, said: ‘For the 900,000 people living with dementia in the UK, it’s likely dementia isn’t the only condition they’re getting treatment for.’

Continuity of care reaps rewards

The researchers performed a retrospective cohort study using anonymised medical records, data coming from the Clinical Practice Research Datalink, of patients living in England, with 1 year of follow up.

Included in the study were 9324 individuals, all aged 65 years or older, who had been diagnosed with dementia at any time before the study start date (1 January 2016). The mean age of those included in the study was 84.5 years old, and 67.5% were female. In addition to dementia, 92.1% had at least one additional comorbidity, with 55.7% having three or more additional conditions.

All patients in the study had had at least three consultations from 1 January to 31 December 2015 leading up to the study start date, and during this lead-in period patients with dementia had an average of 14.5 GP consultations. Study participants were followed up for an average of 327.2 days, with 80.4% being followed up for the maximum 1 year.

For patients with dementia who were consistently seen by the same GP over the course of a year, the team found these patients were given fewer medications, and were also less likely to be given drugs associated with adverse effects, such as incontinence, drowsiness, and falls.

‘Higher levels of continuity of GP care were associated with a reduction in incidence of delirium (34.8%), incontinence (57.9%), and emergency hospital admission (9.7%)’, said the authors, when compared with those patients with dementia who had the most variation in the GPs treating them.

Dr João Delgado said: ‘Our research shows that seeing the same general practitioner consistently over time is associated with improved safe prescribing and improved health outcomes. This could have important healthcare impacts, including reduced treatment costs and care needs.’

The authors concluded that higher continuity of GP care for patients with dementia was associated with ‘safer prescribing and lower rates of major adverse events’.

NHS pressures should not be a barrier to continuity

Sir Denis Pereira Gray said: ‘These new findings show that GP continuity is associated with important benefits for patients.’

The authors emphasised how ‘increasing continuity of care for patients with dementia may help improve treatment and outcomes.’

Dr Oakley added: ‘The pandemic has put GP services under immense pressure, so while we might not be able to get consistent GP care for everyone with dementia tomorrow, policy makers should absolutely be working with the NHS to build this into their plans as we emerge from the pandemic.’

This article originally appeared on Medscape, part of the Medscape Professional Network.

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