In patients with asthma or chronic obstructive pulmonary disease (COPD), having a continuous relationship with the same health care provider may lower health care costs, reduce risk of unplanned health care consumption, and prevent premature death as suggested by low to moderate certainty evidence, according to systematic review published recently in eClinicalMedicine.
Meeting with the same health care provider regularly, or relational continuity, may facilitate more frequent and effective monitoring of conditions and subsequent adjustment of treatment, thereby improving the quality of care. Researchers sought to evaluate the consequences of relational continuity in treating individuals with asthma or COPD. The primary outcomes included death, health care utilization, and costs.
The investigators conducted a systematic review between January 2000 and February 2021 of CINAHL, Medline, PsycINFO, Scopus, Embase, Cochrane Library, Database of Systematic Review of Effects, DARE, Epistemonikos, NICE Evidence Search, KSR Evidence and AHRQ databases that included 14 observational and 1 randomized controlled trial concerning relational continuity (between patients and either a health professional or team of health professionals) and clinical outcomes for adults at least 18 years of age with asthma and/or COPD.
Premature death was prevented with low certainty (2 studies, n=111,545) comparing higher to lower relational continuity of care; risk of emergency department visits was reduced with low certainty (5 studies, n=362,305); risk of hospitalization was reduced with moderate certainty (9 studies, n=525,716); and health care costs were lowered with low certainty (4 studies, n=390,682). Analysis relating to patient perceptions and treatment adherence involved very low certainty.
Researchers concluded that, “Low to moderate certainty evidence suggests that higher versus lower relational continuity of care for persons with asthma or COPD prevents premature mortality, lowers risks of unplanned health care utilization, and reduces health care costs.” These results may have value for planning health care and creating treatment guidelines, the researchers added.
Review limitations included the use of English-only studies from 2000 forward; the preponderance of nonrandomized studies, which increased risk of bias; selection bias in most studies; and heterogeneity in the analytic approaches of all studies.
Lytsy P, Engström S, Ekstedt M, et al. Outcomes associated with higher relational continuity in the treatment of persons with asthma or chronic obstructive pulmonary disease: A systematic review. EClinicalMedicine. Published online June 3, 2022. doi:10.1016/j.eclinm.2022.101492