Association between continuity of care and subsequent diagnosis of multimorbidity in Ontario, Canada from 2001–2015: A retrospective cohort study

Abstract

Background Continuity of care is a well-recognized principle of the primary care discipline owing to its medical, interpersonal, and cost-saving benefits. Relationship continuity or the ongoing therapeutic relationship between a patient and their physician is a particularly desirable goal, but its role in preventing the accumulation of chronic conditions diagnoses in individuals is unknown. The objective of this study was to investigate the effect of continuity of care with physicians on the rate of incident multimorbidity diagnoses in patients with existing conditions. Methods This was a population-based, retrospective cohort study from 2001 to 2015 that focused on patients aged 18 to 105 years with at least one chronic condition (n = 166,665). Our primary exposure was relationship continuity of care with general practitioners and specialists measured using the Bice-Boxerman Continuity of Care Index (COCI). COCI was specified as a time-dependent exposure prior to the observation period. Our outcomes of interest were the time to diagnosis of a second, third, and fourth chronic condition estimated using cause-specific hazard regressions accounting for death as a competing risk. Findings We observed that patients with a single chronic condition and high continuity of care (>0.50) were diagnosed with a second chronic condition or multimorbidity at an 8% lower rate compared to individuals with low continuity (cause-specific hazard ratio (HR) 0.92 (95% Confidence Interval 0.90–0.93; p<0.0001) after adjusting for age, sex, income, place of residence, primary care enrolment, and the annual number of physician visits. Continuity remained protective as the degree of multimorbidity increased. Among patients with two conditions, the risk of diagnosis of a third chronic condition was also 8% lower for individuals with high continuity (HR 0.92; CI 0.90–0.94; p<0.0001). Patients with three conditions and high continuity had a 9% lower risk of diagnosis with a fourth condition (HR 0.91; CI 0.89–0.93; p<0.0001). Conclusions Continuity of care is a potentially modifiable health system factor that reduces the rate at which diagnoses of chronic conditions are made over time in patients with multimorbidity. Additional research is needed to explain the underlying mechanisms through which continuity is related to a protective effect and the clinical sequalae.

Continuity of care in diverse ethnic groups: a general practice record study in England

“…Relational continuity of care may be particularly important for people with multiple long-term conditions (5) as it has also been associated with lower risk of unscheduled hospital care and slower progression to additional conditions. (6,7). UK evidence on the association between number of long-term conditions and relational continuity is mixed.…”

Continuity of GP care for patients with dementia: impact on prescribing and the health of patients

“… 27 Benefits to health may extend beyond prevention of AHOs as higher continuity of care has also been associated with slower progression of comorbid conditions. 28 Patients with dementia are therefore a key patient group to benefit from higher CGPC.…”

Relational Continuity of Chronic Patients with Primary and Secondary Care Doctors: A Study of Public Healthcare Networks of Six Latin American Countries

“…To date, RC has mostly been studied in Europe and high-income countries mainly through quantitative studies based on patient surveys, or indirectly through the calculation of indicators based on clinical records. Most of the studies available focus on analysing just one attribute of RC in primary care [ 13 , 14 , 15 , 16 , 17 ], and very few on secondary care [ 18 ] or on both levels [ 19 ]. These generally study the association between consistency of the PC doctor (the number of visits to/by the same doctor) and care quality, the use of services, or the patient’s adherence to prescribed treatments [ 13 , 16 , 17 , 20 ].…”

“…Most of the studies available focus on analysing just one attribute of RC in primary care [ 13 , 14 , 15 , 16 , 17 ], and very few on secondary care [ 18 ] or on both levels [ 19 ]. These generally study the association between consistency of the PC doctor (the number of visits to/by the same doctor) and care quality, the use of services, or the patient’s adherence to prescribed treatments [ 13 , 16 , 17 , 20 ]. Studies focusing comprehensively on the different attributes and dimensions of RC are highly scarce [ 10 , 12 ].…”

“…Studies focusing comprehensively on the different attributes and dimensions of RC are highly scarce [ 10 , 12 ]. Consistency of the PC doctor is associated with a greater use of preventive services [ 20 ], shorter hospital stays [ 16 , 17 ], fewer visits to emergency services [ 15 ], and a lower risk of diagnosis of a chronic disease [ 13 ]. The few studies that have analysed consistency of care in SC report that patients seen by the same specialist place greater trust in their doctor, which in turn, is associated with better adherence to treatment [ 18 ].…”