Team-based Continuity of Care for Patients with Hypertension: A Retrospective Cohort Study in Primary Care

Wanchun Xu; Esther Yee Tak Yu; Weng-yee Chin; Ivy Lynn Mak; Cheyenne I Ying Chan; Cindy Lo Kuen Lam; Eric Yuk Fai Wan

doi:10.3399/BJGP.2023.0150

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Championing team-based care: a new gold standard for hypertension management?
Ryuichi Ohta

Published on: 23 July 2023

Published on: (23 July 2023)
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Championing team-based care: a new gold standard for hypertension management?
Ryuichi Ohta, Family physician, Unnan City Hospital, Japan
I am writing in response to the study recently published in your esteemed journal titled " Team-based Continuity of Care for Patients with Hypertension: A Retrospective Cohort Study in Primary Care ".¹ This investigation presents valuable insights into the application and benefits of team-based continuity of care (COC) in the primary care setting for hypertension patients, addressing a significant gap in our understanding. Several vital points warrant further discussion.

The sheer size of the cohort (421,640 patients over a decade) speaks volumes about the robustness of the findings. The rigorous methodology strengthens the conclusions drawn by utilizing the usual provider continuity index and advanced statistical tools like Cox regression and restricted cubic splines. The reported hazard ratios across quartiles strongly suggest a dose-response relationship, implying a more profound benefit of COC with increasing consistency of care. Notably, the significantly reduced risk of cardiovascular diseases (CVD) and all-cause mortality is a crucial takeaway that should resonate within the broader clinical community. The subgroup analysis provides essential clinical pearls. The fact that younger patients (<65 years), those with unsatisfactory blood pressure control, and patients with a lower Charlson Comorbidity Index exhibit more significant CVD risk reduction underscores the importance of early and consistent intervention.

While the findin...
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I am writing in response to the study recently published in your esteemed journal titled " Team-based Continuity of Care for Patients with Hypertension: A Retrospective Cohort Study in Primary Care ".¹ This investigation presents valuable insights into the application and benefits of team-based continuity of care (COC) in the primary care setting for hypertension patients, addressing a significant gap in our understanding. Several vital points warrant further discussion.

The sheer size of the cohort (421,640 patients over a decade) speaks volumes about the robustness of the findings. The rigorous methodology strengthens the conclusions drawn by utilizing the usual provider continuity index and advanced statistical tools like Cox regression and restricted cubic splines. The reported hazard ratios across quartiles strongly suggest a dose-response relationship, implying a more profound benefit of COC with increasing consistency of care. Notably, the significantly reduced risk of cardiovascular diseases (CVD) and all-cause mortality is a crucial takeaway that should resonate within the broader clinical community. The subgroup analysis provides essential clinical pearls. The fact that younger patients (<65 years), those with unsatisfactory blood pressure control, and patients with a lower Charlson Comorbidity Index exhibit more significant CVD risk reduction underscores the importance of early and consistent intervention.

While the findings are remarkable, it would be pertinent to further elaborate on the insignificance of effects observed among participants with reduced estimated glomerular filtration rate. Kidney function is undeniably interlinked with hypertension management and cardiovascular outcomes; exploring this aspect in-depth could offer additional insights. The concluding remarks on how team-based COC via a physician group could be a boon for healthcare systems with scarce resources are well-placed. Rural contexts need various systems sustaining COC.² Such a model ensures comprehensive care and addresses workforce challenges, ensuring patients receive consistent and coordinated care even without their primary physician.³

In conclusion, this study is a welcome addition to the literature and paves the way for a paradigm shift in our approach to managing hypertension in primary care. I hope that this research instigates further exploration in this realm and aids in the development of policies promoting team-based COC as a gold standard in hypertension management.

References
1. Wanchun X, Esther Yee Tak Y, Weng-yee C, et al. Team-based Continuity of Care for Patients with Hypertension: A Retrospective Cohort Study in Primary Care. Br J Gen Pract 2023:BJGP.2023.0150. DOI: 10.3399/BJGP.2023.0150.
2. Cubaka VK, Dyck C, Dawe R, et al. A global picture of family medicine: the view from a WONCA Storybooth. BMC Fam Pract 2019;20(1):129. (In eng). DOI: 10.1186/s12875-019-1017-5.
3. Ohta R, Ueno A, Kitayuguchi J, Moriwaki Y, Otani J, Sano C. Comprehensive Care through Family Medicine: Improving the Sustainability of Aging Societies. Geriatrics (Basel) 2021;6(2) (In eng). DOI: 10.3390/geriatrics6020059.
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Competing Interests: None declared.