Association between continuity of care and detection of hypertension in Dutch general practice: a 10-year cohort study.

The overall incidence rate of hypertension detection in the study cohort was 9.42 diagnoses per 1000 person-years.

• 95% CI 9.20 to 9.64 per 1000 person-years
• Study population included 106,755 adults without known cardiovascular diseases or risk factors at baseline
• Cohort was 59.5% female with a median age of 35 years
• Data drawn from 48 Dutch general practices between 2013 and 2022

Intermediate and high GP-level continuity of care were associated with significantly higher hazard ratios of hypertension detection compared to low GP-COC.

• Intermediate GP-COC had an HR of 1.9 (95% CI 1.7 to 2.1) compared to low GP-COC
• High GP-COC had an HR of 4.9 (95% CI 4.4 to 5.4) compared to low GP-COC
• The association was dose-dependent across COC levels
• A multivariable Cox proportional hazard regression model was used to assess the association

Intermediate and high team-level continuity of care were associated with even higher hazard ratios of hypertension detection compared to low team-COC.

• Intermediate team-COC had an HR of 2.3 (95% CI 2.2 to 2.5) compared to low team-COC
• High team-COC had an HR of 7.3 (95% CI 6.8 to 7.8) compared to low team-COC
• Team-COC HRs were larger in magnitude than corresponding GP-COC HRs at both intermediate and high levels
• The association was dose-dependent across COC levels

High personal continuity of care was associated with earlier detection of hypertension by up to 8.3 months.

• 95% CI for earlier detection was 7.9 to 8.6 months (reported in abstract as 8.6 to 7.9 months)
• This finding pertains specifically to high personal (GP-level) continuity of care
• Earlier detection was compared against the low COC reference group

The Herfindahl-Hirschman Index was used to quantify both GP-level and team-level continuity of care.

• The Herfindahl-Hirschman Index is described as 'an established measure for COC'
• COC was categorized into three levels: low, intermediate, and high
• Both GP-COC and team-COC were calculated separately and analyzed independently
• The study used routine care data from 48 Dutch general practices spanning 2013 to 2022

The association between continuity of care and hypertension detection was dose-dependent for both GP-COC and team-COC.

• Higher levels of both GP-COC and team-COC were associated with progressively higher hazard ratios of hypertension detection
• This dose-dependent pattern held for both measures of continuity (GP and team level)
• The authors conclude that 'promoting COC contributes to cardiovascular preventive care'