{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T23:59:59Z","timestamp":1789603199031,"version":"build-2803163510"},"reference-count":20,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T00:00:00Z","timestamp":1750723200000},"content-version":"unspecified","delay-in-days":23,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,6,6]]},"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Angina, a major manifestation of ischaemic heart disease, affects 3\u20137% of adults and is a leading cause of cardiovascular morbidity. As an ambulatory care-sensitive condition, its outcomes can be improved through proactive outpatient management. However, the real-world impact of continuity of care (COC) and medication adherence, measured by the medication possession ratio (MPR)\u2014on angina complications in South Korea remains poorly understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study evaluated the effectiveness of COC and MPR in patients with angina using comprehensive national data and examined the outcomes at the hospital level.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study used data from the National Health Insurance Service of Korea between 2002 and 2019. We identified 11\u2009127 patients aged &gt;30 years newly diagnosed with angina, applying strict exclusion criteria to ensure cohort validity. COC was categorised as high (COC index=1.0) or low (&lt;1.0), and MPR was classified as excellent (\u226580%), good (60%\u201379%) or poor (&lt;60%). Complications, defined as the onset of coronary artery disease (International Classification of Diseases, 10th Revision: I20\u2013I25), were analysed using Kaplan-Meier survival curves and Cox proportional hazards models, adjusting for key sociodemographic and clinical covariates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among the study cohort (mean age 63.4 years; 54.3% female), 64.2% had low COC. While patients with low COC had a 20% higher risk of complications compared with those with high COC (HR: 1.20; 95%\u2009CI: 0.87 to 1.65; p=0.266), this was not statistically significant. Similarly, patients with poor MPR had a modestly elevated but non-significant risk (HR: 0.96; 95%\u2009CI: 0.67 to 1.36). Subgroup analysis revealed significantly elevated complication risk in patients \u226580 years with low COC (HR: 2.00; 95%\u2009CI: 1.67 to 2.32; p=0.04). The lowest complication rates were observed in patients receiving care from clinics with high COC and excellent MPR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Higher levels of COC and MPR were associated with reduced angina-related complications, underscoring their importance in chronic disease management. However, the inconsistent statistical significance suggests disease-specific strategies may be needed to optimise continuity and adherence interventions. These findings have implications for refining ambulatory care models and enhancing chronic disease policies within Korea\u2019s single-payer system.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-098903","type":"journal-article","created":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T21:16:14Z","timestamp":1750799774000},"page":"e098903","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Continuity of care and medication adherence in patients with angina: a retrospective cohort study using Korea\u2019s National Health Insurance data"],"prefix":"10.1136","volume":"15","author":[{"given":"Dayea","family":"Kim","sequence":"first","affiliation":[{"name":"Graduate School of Public Health, Korea University, Seongbuk-gu, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0443-9291","authenticated-orcid":false,"given":"Jaewoo","family":"Cha","sequence":"additional","affiliation":[{"name":"Preventive Medicine, Korea University, Seongbuk-gu, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,6,24]]},"reference":[{"key":"2025121400493467000_15.6.e098903.1","unstructured":"Mayo Foundation for Medical Education and Research . Angina, 2022. Available: https:\/\/www.mayoclinic.org\/diseases-conditions\/angina\/symptoms-causes\/syc-20369373"},{"key":"2025121400493467000_15.6.e098903.2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.004046"},{"key":"2025121400493467000_15.6.e098903.3","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(24)00933-4"},{"key":"2025121400493467000_15.6.e098903.4","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.116.004080","article-title":"Angina and Future Cardiovascular Events in Stable Patients With Coronary Artery Disease: Insights From the Reduction of Atherothrombosis for Continued Health (REACH) Registry","volume":"5","author":"Eisen","year":"2016","journal-title":"J Am Heart Assoc"},{"key":"2025121400493467000_15.6.e098903.5","doi-asserted-by":"publisher","DOI":"10.1071\/PY07043"},{"key":"2025121400493467000_15.6.e098903.6","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzp059"},{"key":"2025121400493467000_15.6.e098903.7","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.12.1.162"},{"key":"2025121400493467000_15.6.e098903.8","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2010.340"},{"key":"2025121400493467000_15.6.e098903.9","doi-asserted-by":"publisher","DOI":"10.1542\/peds.103.4.738"},{"key":"2025121400493467000_15.6.e098903.10","doi-asserted-by":"publisher","DOI":"10.1370\/afm.3116"},{"key":"2025121400493467000_15.6.e098903.11","doi-asserted-by":"publisher","DOI":"10.1370\/afm.139"},{"key":"2025121400493467000_15.6.e098903.12","doi-asserted-by":"publisher","DOI":"10.1016\/S0277-9536(02)00539-7"},{"key":"2025121400493467000_15.6.e098903.13","unstructured":"NHIS . National Health Insurance Service, Available: https:\/\/nhiss.nhis.or.kr\/bd\/ab\/bdaba012eng.do"},{"key":"2025121400493467000_15.6.e098903.14","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2023-073404","article-title":"Association between medical complications according to continuity of care and medication adherence in patients with hypertension in Korea: a national population-based cohort study","volume":"13","author":"Kim","year":"2023","journal-title":"BMJ Open"},{"key":"2025121400493467000_15.6.e098903.15","doi-asserted-by":"publisher","DOI":"10.1370\/afm.1685"},{"key":"2025121400493467000_15.6.e098903.16","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-197605000-00001"},{"key":"2025121400493467000_15.6.e098903.17","doi-asserted-by":"crossref","first-page":"518","DOI":"10.4093\/dmj.2024.0087","article-title":"Korean National Burden of Disease: The Importance of Diabetes Management","volume":"48","author":"Kim","year":"2024","journal-title":"Diabetes Metab J"},{"key":"2025121400493467000_15.6.e098903.18","doi-asserted-by":"crossref","DOI":"10.3389\/fmed.2025.1564791","article-title":"Impact of blood pressure and medication adherence on clinical outcomes in patients with hypertension","volume":"12","author":"Kim","year":"2025","journal-title":"Front Med (Lausanne)"},{"key":"2025121400493467000_15.6.e098903.19","doi-asserted-by":"crossref","DOI":"10.3346\/jkms.2025.40.e104","article-title":"Advancing Korean Medical Research Through Comprehensive Data Resources","volume":"40","author":"Jung","year":"2025","journal-title":"J Korean Med Sci"},{"key":"2025121400493467000_15.6.e098903.20","doi-asserted-by":"publisher","DOI":"10.1370\/afm.285"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-098903","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T08:49:45Z","timestamp":1765702185000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-098903"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6]]},"references-count":20,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6,24]]},"published-print":{"date-parts":[[2025,6]]}},"alternative-id":["10.1136\/bmjopen-2025-098903"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-098903","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6]]}}}