Context Personal continuity is a widely accepted core value of primary care. Previous studies suggest that personal continuity is associated with fewer Potentially Inappropriate Prescriptions (PIPs). However, this has not been studied in the primary care population. Objective To study the association between personal continuity and PIPs in older patients receiving care from their family physicians. Study Design and Analysis Observational study. To assess the association between personal continuity and PIPs, we conducted linear multilevel regression analyses. Setting or Dataset Anonymized routine care data from 48 Dutch family practices, including 269,478 patients, from 2013 to 2018. Population Studied We included 25,854 patients ≥65 years with ≥5 contacts with their practice. Intervention/Instrument Personal continuity using four established measures: Usual Provider Continuity (UPC); Bice-Boxerman Continuity of Care Index (BBI); Herfindahl Index (HI); Modified Modified Continuity Index (MMCI). Outcome Measures Potentially Inappropriate Medications (PIMs) and Potential Prescribing Omissions (PPOs), based on 100/108 of the STOPP/START-NL v2. Results Using UPC, BBI, HI and MMCI, the mean (SD) personal continuity was 0.70 (0.19), 0.55 (0.24), 0.59 (0.22) and 0.86 (0.14), respectively. The median number of prescriptions was 68; 72.2 and 74.3% had ≥1 PIM or PPO; 30.9 and 34.2% had ≥3 PIMs or PPOs, respectively. Three of four continuity measures (BBI, HI and UPC) were positively and significantly associated with fewer potentially inappropriate prescriptions. Conclusions High personal continuity is associated with appropriate prescribing. Increasing personal continuity may improve quality of prescriptions and reduce harmful consequences.
2023 Annals of Family Medicine, Inc.