Continuity of Care for Asthma, COPD Patients Could Improve Survival, Cut Costs

For patients with asthma or chronic obstructive pulmonary disease (COPD), having an ongoing relationship with the same health care provider may have significant individual and health system benefits, including reduced health care costs, lower risk for unplanned health care utilization, and prevention of premature mortality.

Findings on the potential impact of “relational continuity of care” in the 2 populations come from a systematic literature review just published in the Lancet’s eClinical Medicine.

Relational continuity, the study authors write, may lead to enhanced communication between clinician and patient, which in turn may facilitate more frequent and effective disease monitoring and adjustments to treatment, culminating in overall improved quality of patient care and outcomes.

According to the investigators, led by Jenny Berg, PhD, of SBU—Swedish Agency for Health Technology Assessment and Assessment of Social Services in Stockholm, existing systematic reviews on continuity of care in asthma and COPD cover disease management vs relational continuity and focus solely on mortality. They believe this is the first systematic review to evaluate the effects of relational continuity of care specifically and identified primary study outcomes as mortality, morbidity (symptoms and functioning) and health care utilization (emergency department visits, hospitalizations).

The systematic review comprised 11 databases searched between January 2000 and February 2021 for controlled and observational studies of relational continuity (between patients and either a health professional or team of health professionals). Study populations were adults aged at least 18 years with a diagnosis of asthma and/or COPD. Length of exposure required was at least 12 months.

Findings

The search returned 2824 unique references and the final review was conducted on 15 studies (14 observational and 1 randomized controlled trial). Overall, certainty of evidence for the impact of higher vs lower relational continuity of care on the primary outcomes ranged from low to moderate, as follows:

• Prevention of premature death, low certainty (2 studies, n=111 545)
• Reduced risk of emergency department visits, low certainty (5 studies, n=362 305)
• Reduced risk of hospitalization, moderate certainty (9 studies, n=525 716)
• Reduced health care costs, low certainty (4 studies, n=390 682)

While certainty of evidence for findings related to the impact of high relational continuity of care on factors such as patient evaluation of clinical care, disease self-management, and quality of life was assessed as very low, results were consistent in showing the association was positive.

Berg and colleagues 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.”

The authors emphasize that their results may prove valuable for health care professionals planning individual patient care, policy makers conducting cost-estimation exercises, and professional groups tasked with guideline development.

They note among the study's limiation 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.

Reference: Lytsy P, Engstrom 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 2022;49: doi.org/10.1016/j. eclinm.2022.101492