Continuity of care with the same physician is valuable. A good doctor-patient relationship builds knowledge, trust, and respect over time and increases quality of care.
There’s no reason to believe this isn’t just as important for patients living with dementia, yet no study had investigated this, until now.
If you or your loved one is suffering from dementia, here’s what you need to know…
Continuity of care is a life saver — literally. A systematic review published in the British Medical Journal in 2018 concluded that it’s linked to lower mortality. The researchers wrote that “continuity of care is an important feature of medical practice, and potentially a matter of life and death.”
They concluded, “Despite mounting evidence of its broad benefit to patients, relationship continuity in primary care is in decline — decisive action is required from policy makers and practitioners to counter this.”
Psychiatrist Max Pemberton from the United Kingdom agrees. He writes that “increasingly, seeing a doctor has been reduced to sitting in front of someone who barely looks up from their keyboard before issuing you a prescription.
“What a dreadful, diminished experience that is. It completely denies all the evidence that shows the extraordinary value of a trusted doctor-patient relationship.”
This is especially true in dementia care.
Dementia Patients Have More Complex Needs
A study carried out by epidemiologists at the University of Exeter emphasizes the importance of this relationship in dementia care.
It’s very common for those with dementia to have other chronic health conditions. These comorbidities complicate care. This leads to the patient being prescribed a greater number of drugs and the risk of adverse reactions that comes from taking them.
The kind of additional problems those with dementia experience include an increased risk for episodes of severe confusion or delirium, three times the risk of incontinence, and an almost 50 percent greater risk of admission to the hospital compared to non-dementia patients. They should, therefore, be a key group to benefit from continuity of care.
To find out, the researchers analyzed medical records of 9,324 patients aged 65 and over who saw a general practitioner 14.5 times on average over 12 months. The researchers divided up the results into four quarters according to the level of continuity.
The results were revealing.
Safer Prescribing – Improved Treatment – Better Outcomes
Compared to the lowest quartile, those in the highest quartile (highest continuity) had a 34.8 percent lower risk of delirium, a 57.9 percent lower risk of incontinence, and a 9.7 percent lower risk of emergency admission to hospital.
These are significant gains!
In addition, those dementia patients with the most continuity of care had fewer prescribed medications and fewer PIPs – potentially inappropriate prescriptions.
For example, they received fewer prescriptions for benzodiazepines, which cause drowsiness and can lead to falls. They were less likely to receive drugs that can cause constipation. Those with incontinence were also less likely to be prescribed loop diuretics for high blood pressure, which can exacerbate incontinence symptoms.
The researchers concluded their study by writing, “Higher continuity of GP care 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.”
Dr. Richard Oakley, Associate Director of Research at The Alzheimer’s Society in the United Kingdom, commented, saying, “It’s 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 an 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 (National Health Service) to build this into their plans as we emerge from the pandemic.”