The Impact of Interpersonal Continuity of Primary Care on Health Care Costs and Use: A Critical Review

Article Figures & Data

Download figure
Open in new tab
Download powerpoint
Figure 1.
Flowchart of process used to identify relevant articles.

Table 1.

Characteristics of Included Studies by Outcome Category (N = 83 Studies)

Outcome Category	No. of Studies^{^a}	Study Design			Study Location	Study Population
Outcome Category	No. of Studies^{^a}	Retrospective Cohort	Prospective Cohort	Other	Study Location	Study Population
Cost	18	14	3	1	8 United States, 3 Korea, 2 Canada, 2 Taiwan, 1 Belgium, 1 Israel, 1 United Kingdom	General adults or children; patients with dementia, diabetes, CHF, COPD, hypertension, angina, CKD, osteoarthritis, ESRD, hypercholesterolemia, stroke, knee OA, or serious mental illness
Use	79	60	13	6	38 United States, 10 Taiwan, 10 Canada, 6 United Kingdom, 3 Korea, 3 Australia, 2 Brazil, 2 Israel, 2 Norway, 1 Netherlands, 1 Germany, 1 Europe	General population, children, adults, elderly patients, infants, or sexually active women; disease groups including patients with diabetes, cancer, hypertension, knee OA, dementia, CHF, COPD, hypercholesterolemia, serious mental illness, HIV, asthma, hyperlipidemia, ESRD, CAD, OA, osteoporosis, depression, and obesity, as well as children with medical complexities

CAD = coronary artery disease; CHF = congestive heart failure; CKD = chronic kidney disease; COPD = chronic obstructive pulmonary disease; ESRD = end-stage renal disease; OA = osteoarthritis.
↵a Some studies assessed both cost and use outcomes.

Table 2.

Summary Findings of the Association of Continuity With Cost and Use Outcomes (N = 160 Outcomes)

Outcome Category	No. of Outcomes	Association of Continuity With Outcome
Outcome Category	No. of Outcomes	Positive^{^a}	Negative	None or Conflicting
Cost	18	14	1	3
Use	142	95	4	43
Hospitalization	57	38	1	18
ASCS	20	14	1	5
All cause	27	20	0	7
Other	10	4	0	6
ED use	43	35	1	7
Desirable use^{^b}	15	7	1	7
Undesirable use^{^c}	12	8	0	4
Primary care use^{^d}	15	7	0	8

ACSC = ambulatory care–sensitive conditions; ART = antiretroviral therapy; CRC = colorectal cancer; CT = computed tomography; ED = emergency department; HbA_1c = glycated hemoglobin; ICU = intensive care unit; LDL = low-density lipoprotein cholesterol; LVF = left ventricular function; TB = tuberculosis.
↵a Greater continuity was associated with lower costs or with better use outcome (more use of desirable health care services or less use of undesirable health care services).
↵b Guideline-concordant receipt of vaccinations; lead, anemia, and TB screening; prescription drug use; HbA_1c screening; annual LDL screening; annual nephropathy screening; annual serum creatine screening; annual LVF test for patients with heart failure; breast, cervical, CRC, and prostate cancer screening; chlamydia screening; recognition of chronic disease; HIV ART adherence; medication/statin adherence; receipt of medical advice about child nutrition, development, and dental health; primary care follow-up within 30 days of inpatient stay.
↵c CT scan of brain, chest radiograph, and urinalysis; total inpatient and outpatient days; duplicated medication (being prescribed drugs in the same pharmacotherapeutic subgroups by separate physicians with overlapping prescription days); use and overuse of various medical procedures; antibiotic prescriptions; ICU use.
↵d Frequency, number, and type (eg, routine well care) of visits to primary care.