Associations between continuity of primary and specialty physician care and use of hospital-based care among community-dwelling older adults with complex care needs

Jones, Aaron; Bronskill, Susan E.; Seow, Hsien; Junek, Mats; Feeny, David; Costa, Andrew P.

doi:10.1371/journal.pone.0234205

Cited by 24 publications

(39 citation statements)

References 46 publications

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“…Table 1 summarises the study characteristics. Four of the ve studies captured 181,735 adults aged 65 years and over receiving aged care services either at home (178,932 people, Canada) [46,48], in a continuing care retirement community (2468 people, United States of America (USA)) [45] or in residential care (335 people, USA) [44,47]. An additional Australian cluster RCT [44] included 15 residential aged care facilities with an average of 98 beds, indicating approximately 1470 residents were likely to be contributing data.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…Studies examined continuity of care predominantly provided by primary care physicians [45,46,48] or GPs [44,47]. Terminology does vary between countries.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…Relational continuity was quantitatively measured in three studies, using the Bice-Boxerman continuity of care index in the Canadian home care study [48], the average number of primary care physicians seen in the retirement community study [45] and number of primary care physician visits to hospitalised aged care residents [47]. Two studies (one in home care and one in residential aged care) did not measure relational continuity [44,46].…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

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Impact of Relational Continuity of Primary Care in Aged Care: A Systematic Review

Dyer

Suen

Williams³

et al. 2021

Preprint

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Background: Greater continuity of care is associated with lower patient mortality. The aim of this systematic review was to examine the impact of relational continuity between a primary care practitioner and older people receiving aged care services, in residential or home care settings, on health care resource use and person-centred outcomes.Methods: Systematic review of five databases, four trial registries and three grey literature sources to October 2020. Included studies (a) aimed to increase relational continuity with a primary care professional, (b) focus on people receiving aged care services (c) included a comparator and (d) reported outcomes of health care resource use, quality of life, activities of daily living, mortality, falls or satisfaction. Cochrane Collaboration or Joanna Briggs Institute criteria were used to assess risk of bias and GRADE criteria to guide confidence in evidence and conclusions.Results: Heterogeneity in study cohorts, settings and outcome measurement in the five included studies (one randomised) precluded meta-analysis. No included studies examined relational continuity exclusively with non-physician providers. Higher relational continuity with a primary care physician probably reduces emergency department (ED) presentations (moderate certainty evidence; high versus low continuity hazard ratio (HR) 0.90, 95% confidence interval (CI) 0.89–0.92, n=178,686; incidence rate ratio (IRR) 0.91, 95%CI 0.72–1.15, n=246) and may reduce hospital admissions slightly (low certainty evidence; high versus low continuity HR 0.94; 95%CI 0.92–0.96, n=178,686; IRR 0.91, 95%CI 0.76–1.27, n=246) for older community-dwelling aged care recipients. The benefit of providing on-site primary care in residential settings is uncertain (low certainty evidence, 2 studies, n=2,468 plus 15 care homes); whilst there are probably lower hospitalisations and may be fewer ED presentations, there may also be an increase in reported mortality and falls. The benefit of general practitioners’ visits during hospital admission is uncertain (very low certainty evidence, 1 study, n=335).Conclusion: Greater relational continuity with a primary care physician probably reduces ED presentations and may reduce hospitalisations slightly for community-dwelling aged care recipients, thus policy initiatives that increase continuity may have cost offsets. Further studies of approaches to increase relational continuity of primary care in aged care settings are needed.Registration: PROSPERO CRD42021215698

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Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…Studies examined continuity of care predominantly provided by primary care physicians [45,46,48] or GPs [44,47]. Terminology does vary between countries.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

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Impact of Relational Continuity of Primary Care in Aged Care: A Systematic Review

Dyer

Suen

Williams³

et al. 2021

Preprint

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“…Continuity of care has been reported to be essential for the successful treatment of older patients in primary care [ 1 , 2 ]. Continuity of care has been suggested to be one of the main tools with which primary care supports the welfare of its patients [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Differences between recorded diagnoses of patients of an emergency department and office-hours primary care doctors: a register-based study in a Finnish town

Lehto

Mustonen

Raina

et al. 2021

International Journal of Circumpolar Health

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To determine the extent to which it is possible to provide continuity of primary care for those who visit Emergency Departments (EDs) we studied how recorded diagnoses in primary care differ, depending on whether the patient is met in an ED or a primary care office-hours practice. In the present, 12-year follow-up study a report generator of the Electronic Health Record-system provided monthly figures for the number of different recorded diagnoses using the International Classification of Diagnoses (10 th edition, ICD-10) and the total number of ED doctors and office-hour visits to General Practitioners (GPs). The 20 most common diagnoses covered 48.1% of the visits with recorded diagnoses to the office hour GPs and 45.9% of the visits to the doctors of the ED. Of these 20 diagnoses, 10 were common in both systems. These 10 diagnoses constituted about 30% of the diagnoses given by ED doctors. Furthermore, five out of the six most common diagnoses were the same in the ED and office-hours practices. The doctors in EDs and office-hour GPs treat quite similar patient material. This may provide organisational ways to reorganise the work of primary care and to guarantee continuity of care for those who may benefit from it.

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“…For example, higher continuity of physician care and home visits for older patients with complex health care needs or patients nearing end of life are associated with reduced acute care use and health care system costs. [13][14][15][16][17] Medical specialists are often thought to provide care for the specific illness(es) that may be contributing to patients' decline (e.g., oncologist for cancer or cardiologist for heart disease that may be life limiting), whereas family physicians may play the coordinating role. 18 Medical specialists may step back as patients move closer to death and are transitioned to palliative and end-of-life care.…”

mentioning

confidence: 99%

Intensity of outpatient physician care in the last year of life: a population-based retrospective descriptive study

Howard

Hafid

Isenberg

et al. 2021

cmajo

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Background: For many patients, health care needs increase toward the end of life, but little is known about the extent of outpatient physician care during that time. The objective of this study was to describe the volume and mix of outpatient physician care over the last 12 months of life among patients dying with different end-of-life trajectories. Methods:We conducted a retrospective descriptive study involving adults (aged ≥ 18 yr) who died in Ontario between 2013 and 2017, using linked provincial health administrative databases. Decedents were grouped into 5 mutually exclusive end-of-life trajectories (terminal illness, organ failure, frailty, sudden death and other). Over the last 12 months and 3 months of life, we examined the number of physician encounters, the number of unique physician specialties involved per patient and specialty of physician, the number of unique physicians involved per patient, the 5 most frequent types of specialties involved and the number of encounters that took place in the home; these patterns were examined by trajectory.Results: Decedents (n = 359 559) had a median age of 78 (interquartile range 66-86) years. The mean number of outpatient physician encounters over the last year of life was 16.8 (standard deviation [SD] 13.7), of which 9.0 (SD 9.2) encounters were with family physicians. The mean number of encounters ranged from 11.6 (SD 10.4) in the frailty trajectory to 24.2 (SD 15.0) in the terminal illness trajectory across 3.1 (SD 2.0) to 4.9 (SD 2.1) unique specialties, respectively. In the last 3 months of life, the mean number of physician encounters was 6.8 (SD 6.4); a mean of 4.1 (SD 5.4) of these were with family physicians.Interpretation: Multiple physicians are involved in outpatient care in the last 12 months of life for all end-of-life trajectories, with family physicians as the predominant specialty. Those who plan health care models of the end of life should consider support for family physicians as coordinators of patient care.

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Associations between continuity of primary and specialty physician care and use of hospital-based care among community-dwelling older adults with complex care needs

Cited by 24 publications

References 46 publications

Impact of Relational Continuity of Primary Care in Aged Care: A Systematic Review

Impact of Relational Continuity of Primary Care in Aged Care: A Systematic Review

Differences between recorded diagnoses of patients of an emergency department and office-hours primary care doctors: a register-based study in a Finnish town

Intensity of outpatient physician care in the last year of life: a population-based retrospective descriptive study

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