Abstract
PURPOSE Secondary health care services have been under considerable pressure in England as attendance rates increase, resulting in longer waiting times and greater demands on staff. This study’s aim was to examine the association between continuity of care and risk of emergency hospital admission among older adults.
METHODS We analyzed records from 10,000 patients aged 65 years and older in 2012 within 297 English general practices obtained from the Clinical Practice Research Datalink and linked with Hospital Episode Statistics. We used the Bice and Boxerman (BB) index and the appointed general practitioner index (last general practitioner consulted before hospitalization) to quantify patient-physician continuity. The BB index was used in a prospective cohort approach to assess impact of continuity on risk of admission. Both indices were used in a separate retrospective nested case-control approach to test the effect of changing physician on the odds of hospital admission in the following 30 days.
RESULTS In the prospective cohort analysis, the BB index showed a graded, non-significant inverse relationship of continuity of care with risk of emergency hospital admission, although the hazard ratio for patients experiencing least continuity was 2.27 (95% CI, 1.37–3.76) compared with those having complete continuity. In the retrospective nested case-control analysis, we found a graded inverse relationship between continuity of care and emergency hospital admission for both BB and appointed general practitioner indices: for the latter, the odds ratio for those experiencing least continuity was 2.32 (95% CI, 1.48–3.63) relative to those experiencing most continuity.
CONCLUSIONS Marked discontinuity of care might contribute to increased unplanned hospital admissions among patients aged 65 years and older. Schemes to enhance continuity of care have the potential to reduce hospital admissions.
- continuity of care
- primary care
- emergency hospital admission
- longitudinal data
- family practice
- practice-based research
Footnotes
Conflicts of interest: authors report none.
Funding support: This work was funded by the National Institute for Health Research School of Primary Care Research (NIHR SPCR), grant funded round 9, principal investigator R.W.M., project number 246. D.L. is funded by the NIHR Oxford Biomedical Research Centre.
Disclaimer: Views and opinions expressed herein represent those of the authors, not the funding bodies.
Previous presentations: This research was previously presented at the Lancet Public Health Science conference, Cardiff, United Kingdom, November 25, 2016, and at the 45th annual scientific meeting of the Society for Academic Primary Care, Dublin, Ireland, July 6–8, 2016.
Supplementary materials: Available at http://www.AnnFamMed.org/content/15/6/515/suppl/DC1.
- Received for publication December 15, 2016.
- Revision received May 11, 2017.
- Accepted for publication June 5, 2017.
- © 2017 Annals of Family Medicine, Inc.