Impact of relational continuity of primary care in aged care: a systematic review

Abstract

Background Greater continuity of care has been associated with lower hospital admissions and patient mortality. This systematic review aims to examine the impact of relational continuity between primary care professionals 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) focused on older 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 rate confidence in evidence and conclusions. Results Heterogeneity in study cohorts, settings and outcome measurement in the five included studies (one randomised) precluded meta-analysis. None examined relational continuity exclusively with non-physician providers. Higher relational continuity with a primary care physician probably reduces hospital admissions (moderate certainty evidence; high versus low continuity hazard ratio (HR) 0.94; 95% confidence interval (CI) 0.92–0.96, n = 178,686; incidence rate ratio (IRR) 0.99, 95%CI 0.76–1.27, n = 246) and emergency department (ED) presentations (moderate certainty evidence; high versus low continuity HR 0.90, 95%CI 0.89–0.92, n = 178,686; IRR 0.91, 95%CI 0.72–1.15, n = 246) for older community-dwelling aged care recipients. The benefit of providing on-site primary care for relational continuity 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 hospitalisations and ED presentations 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 within aged care, particularly in residential settings, are needed. Review registration CRD42021215698.

Usefulness of STOPP/START criteria and Beers criteria for prescribing in geriatric patients in a tertiary health care center, Raipur, Central India

“…observed that older people who were attending on GP’s ambulatories indicated that pre-frailty and frailty are common conditions that should be identified early to allow effective and personalized management based on the multi-dimensional profile of the individual elderly, suggesting the very key role of a primary/family physician in geriatric care. [ 16 ] The quality of primary care becomes important because of an advanced age, disease complexity, and multi-morbidity, resulting in hospitalization which can be improved by interventions targeting primary care[ 17 30 ] and use of screening tools such as STOPP/START and Beers criteria by the primary/family physician.…”

“…[ 16 ] The quality of primary care becomes important because of an advanced age, disease complexity, and multi-morbidity, resulting in hospitalization which can be improved by interventions targeting primary care and use of screening tools such as STOPP/START and Beers criteria by primary or family physicians. [ 17 ]…”

Association between Primary Care Utilization and Emergency Room or Hospital Inpatient Services Utilization among the Middle-Aged and Elderly in a Self-Referral System: Evidence from the China Health and Retirement Longitudinal Study 2011–2018

“…Thus, patients are willing to actively provide accurate information to physicians. The accumulation of patient information means improved understanding of patient preferences [51], reduced counseling time [52], reduced diagnostic uncertainty [50], and increased patient satisfaction and adherence to treatment regimens, thus, facilitating the management of chronic diseases and reducing inpatient care [53][54][55][56][57]. Furthermore, with more complicated and serious diseases, general practitioners use their professional knowledge to promptly screen and refer the patient.…”

Primary, allied health, geriatric, pain and palliative healthcare service utilisation by aged care residents, 2012–2017

“…5 Coordinated and comprehensive primary health care has the potential to improve the overall health of older people and result in lower risk of hospitalisations and other health events. 6,7 Health assessments, GP management plans and team care arrangements for older people receiving home care packages or medication reviews for people living in permanent residential aged care (PRAC) have been found to be associated with lower mortality rates. 8,9 Despite the Australian Medical Association's 2018 Position Statement calling for a national evaluation of the access and effectiveness of primary care services in the care of older people to ensure their needs are being met, no such evaluation has occurred to date.…”

“…In 2020–21, GPs were the most‐visited health professionals by the general population (>80% saw a GP) 5 . Coordinated and comprehensive primary health care has the potential to improve the overall health of older people and result in lower risk of hospitalisations and other health events 6,7 . Health assessments, GP management plans and team care arrangements for older people receiving home care packages or medication reviews for people living in permanent residential aged care (PRAC) have been found to be associated with lower mortality rates 8,9 …”