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

Abstract

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