Personal Continuity and Appropriate Prescribing in Primary Care

Familiarity and rapport between the patient and physician is built over time through repeated contact. As shown in te Winkel et al’s study, continuity—a core primary care value—is especially important in drug prescription. The authors explore the relationship between personal continuity and potentially inappropriate medication prescription, which encompasses Potentially Inappropriate Medications (PIMs) and Potential Prescribing Omissions (PPOs), by family physicians among older Dutch patients. However, this study undoubtedly shows that among older patients, increasing personal continuity may improve the quality of prescriptions and reduce harmful consequences.
Considering that the study population was limited to patients >=65 years of age, do you expect findings to follow the same trends if younger patients were included as well? Additionally, would greater continuity, in younger patients, also be associated with fewer potentially inappropriate prescriptions?
It should also not be forgotten that often in order to avoid frustrating or difficult patient-physician interactions, the family physicians prescribes inappropriate medication to meet the patient's demands.
Hence the authors' recommendation: family physicians should encourage older patients to schedule appointments with the same family physician and discuss prescribing and deprescribing to reduce potential barriers. Perhaps in the future the practical use of the STOPP and START criteria to identify PIPs could be improved by the development and implementation of a user-friendly, time-efficient (digital) tool to support family physician and their patients in prescription management, including deprescribing.