Determining the Association Between Continuity of Primary Care and Acute Care Use in Chronic Kidney Disease: A Retrospective Cohort Study

Continuity of primary care remains a key tenet in improving health outcomes.1,2 As aspiring healthcare providers, we found Chong’s study to be of great interest. Drawing from a retrospective cohort study of Albertans with chronic kidney disease (CKD), Chong et al. explored the impact of continuity of care on health-related outcomes and acute care utilization. This study is important as evidence suggests that 10% of CKD-related incidents may be avoidable.

Study findings indicate that primary care continuity is associated with less acute care use for CKD patients, implying improved disease management and clinical outcomes. Additionally, gaps in care (i.e., lower continuity) is clearly associated with greater rates of preventable acute care utilization, fewer prescriptions for recommended medications, and less routine albuminuria testing. Chong et al. discuss healthcare models emphasizing time with a primary care physician before nephrology referral as a potential means of improving primary care continuity. Could primary care continuity be fostered by delegating care to mid-level providers such as nurse practitioners and/or physician assistants? Additionally, would widespread routine albuminuria testing in earlier stages of CKD be beneficial in improving overall care? Recognizing that more than half (≈50%) of stage 3 CKD patients progress to late stages (i.e., 4 or 5),3 greater emphasis on primary care continuity is paramount.

The authors assessed primary care continuity in CKD patients over a three-year period (2011 to 2014). While three years is a relatively significant time period to measure continuity, we are curious as to whether your team is following this patient cohort prospectively as well. Further, as primary care continuity was shown to provide both positive patient- and population-level benefits, has Alberta considered implementing outreach efforts to increase primary care visits among patients at greatest risk of poor outcomes? Multi-pronged approaches such as patient assignment to a primary care provider team and deliberate follow-up with patients have been recommended to improve continuity.2 If techniques such as these were to be applied to the low continuity patients studied, do you feel there would there be an increase in continuity over time?

References

1. Jeffers, H., & Baker, M. (2016, August). Continuity of care: Still important in modern-day general practice. The British journal of general practice: the journal of the Royal College of General Practitioners. Retrieved September 29, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4979920/
2. Schwarz, D., Hirschhorn, L. R., Kim, J.-H., Ratcliffe, H. L., & Bitton, A. (2019). Continuity in primary care: A critical but neglected component for achieving high-quality Universal Health Coverage. BMJ Global Health, 4(3). https://doi.org/10.1136/bmjgh-2019-001435
3. Baek SD, Baek CH, Kim JS, Kim SM, Kim JH, Kim SB. Does stage III chronic kidney disease always progress to end-stage renal disease? A ten-year follow-up study. Scand J Urol Nephrol. 2012 Jun;46(3):232-8. DOI: 10.3109/00365599.2011.649045. Epub 2012 May 1. PMID: 22545920.