Better continuity of care has been associated with improved quality of care, and reduced emergency room visits and hospitalizations for ambulatory care sensitive conditions. With better continuity, interactions between patients and providers are productive, trust is established, and patients receive appropriate and timely preventive care and chronic disease management. This idealized version of care continuity is rarely realized particularly for patients with multiple chronic conditions, because the average Medicare fee-for-service beneficiary saw two primary care physicians and five specialists in 2000-2002. To improve care coordination and management of patients with chronic conditions, the patient-centered medical home has been proposed to provide a single, consistent point of care that provides continuity of clinical information and treatment decisions for the patient. Medical homes that leverage information technology to promote longitudinal relationships, care coordination and comprehensiveness, hold promise for improving the care for patients with chronic conditions, particularly patients with multiple conditions. However, continuity of care and medical homes relate not just to appropriate and timely provision of health services with a single point of care, but also to appropriate and timely prescribing of new medications and changing in dosing for existing medications. However, no study to date has examined whether patient care that reflects the principles of a medical home improves the continuity of medication management and health and economic outcomes for patients with multiple chronic conditions. We will address this gap in five aims: 1) Do patients taking medications for two or more ACSCs have more prescribing providers than patients taking medications for one ACSC? 2) Do patients taking medications for two or more ACSCs have more medications prescribed and worse medication adherence than patients taking medications for one ACSC? 3) Do patients taking medications for two or more ACSCs have more emergency room visits and inpatient admissions than patients taking medications for one ACSC? 4) Do patients taking medications for two or more ACSCs have more self-reported medication problems than patients taking medications for one ACSC? 5) What do patients and their providers perceive as the advantages and disadvantages of having a single prescribing provider or multiple prescribing providers? Medical home implementation efforts may need to explicitly coordinate prescribing patterns to optimize patient outcomes if we find that patients with fewer (or a single) prescribers have better adherence, fewer emergency room visits and admissions, and fewer self-reported medication problems than patients with more prescribers. Study results are also likely to suggest targets for future evaluation in health systems where self-referral is common and targets for future intervention development.
Ideal continuity of care has been referred to as seeing the same doctor for all office visits, but it also relates to appropriate and timely prescribing of new medications and changing in dosing for existing medications. Continuity in medication management has not been examined widely, so the purpose of the proposed study is to examine the health and economic consequences of continuity of medication management for veterans with two or more chronic conditions.
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