Wednesday, November 21, 2018

If you have a doctor you like and trust, stay with them - you will live longer!

Having been in practice in Framingham, Massachusetts, for over 35 years, I had quite a few elderly patients. One day when I was making hospital rounds, including seeing two patients over 90, a nurse smilingly said "you know, Dr. Hoffer, your patients just don't die!" I responded jokingly that I made them all sign a contract not to die until I permitted it, and thought no more of it. However, as we move away from having lifetime relationships with our physicians, and as medical care becomes more and more fragmented, it turns out we are losing more than a Norman Rockwell moment. Data now very strongly supports the importance of continuity of care in optimal health outcomes.
A study done in South Korea and published in the Annals of Family Medicine (Nov/Dec 2014) looked at a cohort of over 47,000 patients with newly diagnosed hypertension, diabetes and high cholesterol. They followed these patients for five years. They used standard methods of measuring continuity of care and compared outcomes with greater or less continuity. Those with lower indices of continuity of care had 12% higher death rates, 57% more heart attacks and 44% more strokes than those with higher continuity scores. The results make intuitive sense to me, because all of the conditions they studied are known to respond to medication, and both high blood pressure and high cholesterol have no symptoms and it is well-known that many patients stop taking their prescribed medicines. Having a trusting relationship with your doctor, and regular follow-up, makes it more likely you will follow the plan of care prescribed.
Just this year, a very large "meta-analysis" published in BMJ Open (Pereira Gray DJ et al) looked at 22 studies of the impact of continuity of care on health outcomes. They found very strong association of increased continuity of care with decreased mortality.
Not only is life extended, but costs are lower! A study by Andrew Bazemore at al published in the November 2018 issue of the Annals of Family Medicine looked at a sample of 1.45 million Medicare beneficiaries cared for by 6,551 primary care physicians. Comparing patients in the highest and lowest quintiles of continuity scores, they found that odds of hospitalization were 16% lower with good continuity of care and costs per patient were 14% lower (presumably reflecting less hospitalization).

As we look at needed reforms in our system, it is critical that this data be kept in mind.

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