The association between continuity of care and medication appropriateness for diabetic patients with newly diagnosed hypertension

• Main Authors: Chia-Suei Wang, 王嘉穗
• Other Authors: Christy Pu
• Format: Others
• Language: zh-TW
• Published: 2016
• Online Access: http://ndltd.ncl.edu.tw/handle/53907448941357571257

碩士 === 國立陽明大學 === 醫務管理研究所 === 104 === Background Diabetes and hypertension often occur together in older people. Because these two diseases are chronic and do not pose an immediate health risk, older people tend to ignore them. However, if left untreated, these two diseases can cause kidney, heart and cerebrovascular disease. Therefore, these patients require complete and continuous long-term care to avoid deterioration of the diseases. Continuity of care also reduces health care expenses in the long term. With quality continuity of care and regular follow-ups, the doctor can ensure that the patient has good medication adherence, and if the patient’s health situation deteriorates, the doctor can take immediate corrective action. Quality continuity of care is vital for all chronic illnesses. This study explores the association between quality continuity of care and appropriate medication for diabetic patients with newly diagnosed hypertension. Objectives This study specifically explores the relationship between continuity of care and appropriate medication for diabetic patients with newly diagnosed hypertension in Taiwan. In particular, we looked at how appropriate medication was affected in public versus private hospitals as well as how it was affected for these patients in the four types of hospitals - medical centers, regional hospitals, local community hospitals and health clinics. Method We use the data from National Health Insurance Research Database that consists of one million randomly sampled subjects in 2005. 1,345 patients older than 20 years with previously diagnosed diabetes were newly diagnosed with hypertension in 2005 and were enrolled in this study. The continuity of care index was calculated for each patient from date of diagnosis of hypertension for a period of one year. For each patient, we analyzed whether the first prescription for anti-hypertension was appropriate or not. Cross-sectional analysis was conducted using logistic and poisson regression models to identify the relationship between continuity of care and appropriate medication. Results A patient’s Charlson comorbidity with the type of hospital and doctor are all factors that affect the appropriateness of the medication prescribed. It was found that the better the continuity of care, the lower the possibility was that a patient received inappropriate medication for his/her hypertension (OR=0.54，p-value <0.05). Clinics have higher possibility in prescribing inappropriate medication (OR=1.66，p-value <0.05). Private medical institution have lower possibility in prescribing inappropriate medication (IRR=0.82，p-value <0.05) compared with their public counterpart. Conclusion It was found that better the continuity of care, came higher the appropriate medication for patients with hypertension. Through trust and good communication, a doctor always gave the correct medication to a patient. Conversely, those patients that received poor continuity of care more often than not received inappropriate medication for their hypertension as a result of poor follow-up, poor medication adherence, lack of blood pressure measurements and knowledge of comorbidity diseases. This research demonstrates the association between quality continuity of care and appropriate medication for diabetic patients with newly diagnosed hypertension in 2005 under NHI in Taiwan. It may provide useful information for policy-makers to enact relevant policies to ensure prescription safety for HTN patients.