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

## TL;DR

Higher continuity of care in general practice is linked to earlier detection of hypertension, which can help reduce cardiovascular disease risk.

## Contribution

This study demonstrates a dose-dependent relationship between continuity of care and hypertension detection in adults.

## Key findings

- Patients with high GP-COC had up to 4.9 times higher hazard ratios for hypertension detection compared to low COC.
- High team-COC was associated with up to 7.3 times higher hazard ratios for hypertension detection.
- High continuity of care led to earlier hypertension detection by up to 8.3 months.

## Abstract

Hypertension is a major modifiable risk factor for cardiovascular disease, and timely detection enables interventions that can substantially reduce this risk. General practice, with continuity of care (COC) as one of its core values, plays a pivotal role in hypertension detection. This study aimed to investigate the association between COC and the detection of hypertension in general practice.

Longitudinal dynamic cohort study.

This study used routine care data from 48 Dutch general practices between 2013 and 2022.

106 755 adults without known cardiovascular diseases or risk factors at baseline.

The Herfindahl-Hirschman Index, an established measure for COC, was used to calculate both general practitioner (GP)- and team-COC. A multivariable Cox proportional hazard regression model was used to assess the association between COC level (low, intermediate, high) and the incidence of hypertension detection.

We included 106 755 patients (59.5% female, median age 35 years) in our analysis. The overall incidence rate was 9.42 hypertension diagnoses per 1000 person-years (95% CI 9.20 to 9.64). Compared with low COC, patients receiving intermediate or high GP-COC had a 1.9 (95% CI 1.7 to 2.1) to 4.9 (95% CI 4.4 to 5.4) higher HR of hypertension detection; patients receiving intermediate or high team-COC had a 2.3 (95% CI 2.2 to 2.5) to 7.3 (95% CI 6.8 to 7.8) higher HR of hypertension detection. High personal continuity was associated with up to 8.3 months (95% CI 8.6 to 7.9) earlier detection of hypertension. The association between COC and hypertension detection was dose-dependent.

This study shows that both GP-COC and team-COC are dose-dependently associated with increased HRs and earlier detection of hypertension in adults without preregistered cardiovascular conditions. Promoting COC contributes to cardiovascular preventive care.