Investigating the relationship between continuity of care and patients’ medication use

Medicines are the commonest treatment used by GPs to improve or maintain patients’ health. More patients are being prescribed medication than ever before, while a growing number take multiple medications. Problems with prescribing, such as using the wrong drug or dose, prescribing unnecessary or too few medicines, or a patient not taking a medicine in the way it is prescribed (poor adherence) will limit health benefits and may lead to harms.

Central to primary healthcare delivery is continuity of care, which means seeing the same GP at each visit. This can improve trust and communication between the doctor and patient and may lead to better care for patients. This study’s aim is to find out whether better continuity of care affects the use of medicines. In general, we believe that better continuity may lead to improvements in medication adherence, and the prescription of too little or unnecessary medicines, although will have little effect on potentially hazardous prescribing. In addition, it may be that “perfect” continuity may result in over-familiarity, and lead to poorer prescribing.

We will look at anonymous data from the GP health records of 300,000 adult patients from England. The data contain information on patients’ contact with GPs allowing us to measure their continuity of care. They also include information on prescribed medication allowing us to determine the use of too many or too few medicines, and to measure adherence to the prescribed treatment. By linking the prescribed medication to a database providing information on drug safety we can determine the use of the correct dose and drug.

By better understanding the association between continuity of care and prescribing, we will be able to improve the way we design health services to ensure medicines use is safe and effective.

Co-applicants

Rupert Payne, Chris Salisbury, Richard Morris (Bristol)