Does Higher Continuity of Family Physician Care Reduce Hospitalizations in Elderly People with Diabetes?

Abstract

The objective of this study was to investigate the relationship between continuity of family physician (FP) care and inpatient hospitalizations in elderly people with diabetes who have universally-insured health care. We constructed a population-based retrospective cohort study using a sample of 1143 people aged 65 years or older with newly diagnosed diabetes who were selected from a longitudinal surveillance database in the province of Newfoundland and Labrador (NL), Canada. Continuity of FP care was estimated by 3 chronological indices (Continuity of Care [COC], Usual Provider Continuity [UPC], and Sequential Continuity [SECON]) using administrative physician claims data. Age, sex, number of chronic conditions, and income were used as control variables. People with high continuity had lower crude rates of hospitalization than those with lower continuity. Log-linear regression analysis showed that higher continuity was associated with decreased rates of hospitalization in an unadjusted model [rate ratio (95% confidence interval)]; COC: 0.73 (0.61-0.86); UPC: 0.71 (0.59-0.86); SECON: 0.64 (0.52-0.78), and after adjusting for control variables; COC: 0.82 (0.69-0.97); UPC: 0.82 (0.68-0.98); SECON: 0.75 (0.61-0.91). Other significant predictors of reduced hospitalizations were female sex, fewer chronic conditions, and higher income. The findings suggest that high levels of continuity of FP care are associated with reduced hospitalizations in elderly people with diabetes within a universally-insured health care system.

Factors Associated With Frequent Emergency Department Use in the Medicare Population

“…A prior study using the Community Tracking Survey found that individuals who were treated by the same physician at every outpatient visit were 33% less likely to be frequent ED users than those who were treated by several different physicians (Hunt et al, 2006). Our findings add to a growing body of evidence suggesting that improved continuity of care reduces utilization of high-intensity health care resources (Bayliss et al, 2015;Bentler et al, 2014;Chen & Cheng, 2010;Cheng et al, 2011;Ionescu-Ittu et al, 2007;Knight et al, 2009;Lin et al, 2010;Menec et al, 2006;Nyweide et al, 2013).…”

Spatial Accessibility to Health Care Services: Identifying under-Serviced Neighbourhoods in Canadian Urban Areas

“…In general, therefore, the findings of this study have a number of policy implications for improving geographic accessibility to health care services in Canadian urban settings. Consistent with the aims of Canada’s Strategy for Patient-Oriented Research (SPOR) [103, 104] and for better access to PHC services in order to decrease emergency visit to seek PHC services that could be provided by family physicians [105–107], this study provides evidence to inform progressive and accessible PHC, all fundamental to actualizing the Act and benefiting the health of urban residents. Such as neighbourhoods with poor geographical accessibility to PHC services and high health care needs can be focused in the process of urban area development by city planners by ensuring/ providing / allocating business spaces for family physicians.…”

Factors associated with mode of colorectal cancer detection and time to diagnosis: a population level study

“…Each patient was identified with presence or absence of GI-related comorbidities. The Usual Provider Continuity (UPC) index, a measure of continuity of care with a primary care physician, was derived based on GP visits in the two years prior to diagnosis [22]. Statistics Canada data from 2006 were used as a source of patients’ median household income for each census dissemination area (DA), an area including approximately 600 households.…”