# Association between patient continuity of care and physicians’ hypoglycaemic medication prescription trends

## TL;DR

The study finds that stronger patient-physician relationships and continuity of care are linked to higher prescription rates of diabetes medications, with specialists and public payers showing distinct patterns.

## Contribution

This study introduces a novel analysis of how continuity of care and physician specialty influence diabetes medication prescriptions, revealing differences in prescription trends.

## Key findings

- Specialists prescribe fewer DPP-4i and SGLT2i medications compared to GPs but more GLP-1 medications.
- Physicians with higher continuity of care prescribe more diabetes medications like DPP-4i, SGLT2i, and GLP-1.
- Public payers are associated with significantly lower prescription rates for all three medications compared to private payers.

## Abstract

The general prevalence of chronic non-communicable diseases, such as diabetes mellitus is rapidly increasing while exacerbating the burden of disease on healthcare systems. Its management, as opposed to communicable diseases, is typically long term and requires ongoing healthcare interventions, such as dietary control and medication prescription, with associated costs. The prescription requires an interaction between patients and physicians, which may be sporadic or continuous, and can be used as a proxy measure for the strength of patient–doctor relationship. We hypothesize that fragmentation of care, across physician specialties and payers, plays a role on prescription behaviour, above and beyond for patient and prescription characteristics. A panel of patients’ prescriptions events with the universe of all prescriptions and dispensing in Portugal from January 2015 to October 2019 (N = 791.467) provided by Serviços Partilhados do Ministério da Saúde, EPE was considered. We measured the association between care fragmentation of care and prescription behavior of antihyperglycaemic medication using negative binomial regression models. Results suggest that Specialists play a secondary role on the prescription of DPP-4i and SGLT2i, prescribing 12.3 and 4.3% less respectively, while playing a central role on the prescription of GLP-1, in comparison with GPs. Fragmentation of care also plays a part on prescription trends, i.e., physicians with higher of continuity of care present higher rates of prescription of approximately 5.9% for DPP-4i, 6.5% for SGLT2i and 39.6% for GLP-1. The comparison of prescription trends amongst public and private payers suggests that public payers have lower rates of prescriptions (DPP-4i: 9.6%; SGLT2i: 7.2%; GLP-1: 85.6%). We find important differences in prescription patterns between specialists and primary care physicians. Higher continuity of care is associated with increased prescription frequency. Finally, public payers are associated with lower prescription rates. Physician specialty, payer, and care fragmentation all interact in the prescription patterns of antihyperglycaemic medication.