Dementia patients who see the same GP every time are 35% less likely to develop delirium, almost 60% less likely to experience incontinence, 10% less likely to have an emergency hospitalisation, as well as having a better overall quality of life, found a large UK study.
More than 900,000 people live with dementia in the UK. The figure is about 57m globally, and this is likely to nearly triple to 153m by 2050. Delirium and incontinence are not only very distressing for patients, but additional hospital admissions can also be costly for the National Health Service (NHS), the researchers said.
The University of Exeter research, published in the British Journal of General Practice, analysed records of more than 9,000 people aged 65 and over in England living with dementia in 2016.
“In the absence of a cure, long-term care is particularly important,” said the studyʼs lead author, Dr João Delgado of the University of Exeter. “Treating people with dementia can be complex, because it often occurs with other common diseases.
“Our research shows that seeing the same GP 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.”
Sir Denis Pereira Gray, study co-author and a GP researcher at Exeterʼs St Leonardʼs Practice, said the findings showed that having a named GP was associated with important benefits for patients.
“While national policymakers have, for years, discouraged continuity, general practices can still provide good GP continuity through their internal practice organisation, for example by using personal lists,” he added.
Dr Richard Oakley, associate director of research at Alzheimerʼs Society, said: “Itʼs clear from this study that consistently seeing the same GP has real benefits for people living with dementia – better management and treatment of conditions, and lower risk of complications like delirium and incontinence, leading to improved quality of life.
“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, policymakers should absolutely be working with the NHS to build this into their plans as we emerge from the pandemic.”
The study concluded that higher continuity of GP care for patients with dementia was “associated with safer prescribing” and “lower rates of major adverse events”.
“Continuity of care is highly valued by patients and GPs, and there is strong research evidence that it is associated with better outcomes for patients and more effective use of NHS services,” said Prof Martin Marshall, chair of the Royal College of GPs, reports The Guardian. “This research confirms these findings and shows it can be particularly beneficial for patients suffering from dementia.”
Marshall said although GPs wanted to provide the best care to all their patients, including continuity for those who want and value it, “escalating GP workload and workforce shortages” meant that it had become increasingly difficult to deliver.
He added: “Ultimately, what is needed to allow GPs to deliver continuity of care to those patients who value it is more GPs and more members of the practice team so that we can spend more time with patients. The government must urgently deliver on its manifesto pledge of 6,000 more GPs and thousands more members of the practice team so that GPs are able to give patients with dementia, and all their patients, the care they need and deserve.”
Study details
Continuity of GP care for patients with dementia: impact on prescribing and the health of patients
João Delgado, Philip H Evans, Denis Pereira Gray, Kate Sidaway-Lee, Louise Allan, Linda Clare, Clive Ballard, Jane Masoli, Jose M Valderas and David Melzer.
Published in the British Journal of General Practice on 24 January 2022
Abstract
Background Higher continuity of GP care (CGPC), that is, consulting the same doctor consistently, can improve doctor–patient relationships and increase quality of care; however, its effects on patients with dementia are mostly unknown.
Aim To estimate the associations between CGPC and potentially inappropriate prescribing (PIP), and with the incidence of adverse health outcomes (AHOs) in patients with dementia.
Design and setting A retrospective cohort study with 1 year of follow-up anonymised medical records from 9324 patients with dementia, aged ≥65 years living in England in 2016.
Method
CGPC measures include the Usual Provider of Care (UPC), Bice–Boxerman Continuity of Care (BB), and Sequential Continuity (SECON) indices. Regression models estimated associations with PIPs and survival analysis with incidence of AHOs during the follow-up adjusted for age, sex, deprivation level, 14 comorbidities, and frailty.
Results
The highest quartile (HQ) of UPC (highest continuity) had 34.8% less risk of delirium (odds ratio [OR] 0.65, 95% confidence interval [CI] = 0.51 to 0.84), 57.9% less risk of incontinence (OR 0.42, 95% CI = 0.31 to 0.58), and 9.7% less risk of emergency admissions to hospital (OR 0.90, 95% CI = 0.82 to 0.99) compared with the lowest quartile. Polypharmacy and PIP were identified in 81.6% (n = 7612) and 75.4% (n = 7027) of patients, respectively. The HQ had fewer prescribed medications (HQ: mean 8.5, lowest quartile (LQ): mean 9.7, P<0.01) and had fewer PIPs (HQ: mean 2.1, LQ: mean 2.5, P<0.01), including fewer loop diuretics in patients with incontinence, drugs that can cause constipation, and benzodiazepines with high fall risk. The BB and SECON measures produced similar findings.
Conclusion
Higher CGPC for patients with dementia was associated with safer prescribing and lower rates of major adverse events. Increasing continuity of care for patients with dementia may help improve treatment and outcomes.
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