Association between continuity of care in general practice and hospital admissions for ambulatory care sensitive conditions: cross sectional study of routinely collected, person level data

Barker, Isaac; Steventon, Adam; Deeny, Sarah R

doi:10.1136/bmj.j84

Cited by 330 publications

(341 citation statements)

References 28 publications

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“…The study of Barker et al 10 was one of the first in the United Kingdom to link continuity of care and number of hospital admissions using individual-level data. Our study used individual-level longitudinal data, allowing a stronger basis for inferring a causal relationship between continuity of care and first emergency hospital admission between April 2012 and March 2014.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

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Continuity of Primary Care and Emergency Hospital Admissions Among Older Patients in England

et al. 2017

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PURPOSE Secondary health care services have been under considerable pressure in England as attendance rates increase, resulting in longer waiting times and greater demands on staff. This study's aim was to examine the association between continuity of care and risk of emergency hospital admission among older adults. METHODSWe analyzed records from 10,000 patients aged 65 years and older in 2012 within 297 English general practices obtained from the Clinical Practice Research Datalink and linked with Hospital Episode Statistics. We used the Bice and Boxerman (BB) index and the appointed general practitioner index (last general practitioner consulted before hospitalization) to quantify patient-physician continuity. The BB index was used in a prospective cohort approach to assess impact of continuity on risk of admission. Both indices were used in a separate retrospective nested case-control approach to test the effect of changing physician on the odds of hospital admission in the following 30 days. RESULTSIn the prospective cohort analysis, the BB index showed a graded, nonsignificant inverse relationship of continuity of care with risk of emergency hospital admission, although the hazard ratio for patients experiencing least continuity was 2.27 (95% CI, 1.37-3.76) compared with those having complete continuity. In the retrospective nested case-control analysis, we found a graded inverse relationship between continuity of care and emergency hospital admission for both BB and appointed general practitioner indices: for the latter, the odds ratio for those experiencing least continuity was 2.32 (95% CI, 1.48-3.63) relative to those experiencing most continuity.CONCLUSIONS Marked discontinuity of care might contribute to increased unplanned hospital admissions among patients aged 65 years and older. Schemes to enhance continuity of care have the potential to reduce hospital admissions. 2017;15:515-522. https://doi Ann Fam Med

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Section: Comparison With Existing Literaturementioning

confidence: 99%

“…Salisbury et al 8 focused on multimorbidity and continuity of care, while Ridd et al 9 focused on continuity and diagnosis of cancer, but neither included acute care. Barker et al 10 found an association between higher continuity of care and fewer admissions for ambulatory care-sensitive conditions.…”

Section: Introductionmentioning

confidence: 99%

Continuity of Primary Care and Emergency Hospital Admissions Among Older Patients in England

et al. 2017

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“…Angesichts der Bedeutungszunahme chronisch behandlungsbedürftiger Krankheiten und fortschreitender Spezialisierung in der Medizin wird in den meisten Gesundheitssystemen nach Wegen zur Verbesserung der Kooperation und Koordination der Behandlungsprozesse gesucht [6] Der Gedanke lässt sich auch auf das deutsche Gesundheitssystem übertragen, in dem Patienten größte Wahlfreiheiten genießen. Nicht zuletzt aufgrund der hohen Zahl von Arztkontakten [7,8] sowie der zunehmenden Krankenhausaufnahmen ohne ärztliche Einweisung (vgl.…”

Section: Dominik Von Stillfried · Tatiana Ermakova · Frank Ng · Thomaunclassified

Virtuelle Behandlernetzwerke

Stillfried

Ermakova

et al. 2017

Bundesgesundheitsbl

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“…For example, there is evidence in primary care that continuity of care in general practice is linked to improved outcomes such as prevention of secondary care admissions (Barker et al . ) and continuity of care is also associated with heightened patient satisfaction in systematic reviews of the literature (Adler et al . ).…”

Section: Discussionmentioning

confidence: 99%

Development and evaluation of dedicated low clearance transplant clinics for patients with failing kidney transplants

Arshad

Jackson-Spence

Sharif

2019

Journal of Renal Care

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SUMMARY Background Recipients with failing kidney transplants (RFKTs) may receive sub‐optimal care compared with patients with native kidney disease. The aim of this study is to compare the outcomes of RFKTs managed in a dedicated low clearance transplant clinic (LCTC) compared with those attending a general transplant clinic. Methods We undertook a retrospective analysis of patients with failing kidney transplants comparing two clinics—a LCTC versus a general transplant clinic. Kidney transplant recipients with an eGFR < 20 ml/min were included. A cross‐sectional analysis was undertaken of all patients with two consecutive follow‐up visits between the dates of January and July 2016 in either clinic, with follow‐up to event or December 2017. Results Data were analysed for 141 kidney transplant recipients; 60 in the LCTC and 81 in the general transplant clinic. More patients in the LCTC cohort were non‐white and early transplant recipients. A significantly greater proportion of LCTC versus general transplant patients had received documented discussions regarding their hepatitis vaccine status (63.3% vs. 17.3%, p < 0.001), counselled regarding dialysis modality (98.3% vs. 55.6%, p < 0.001) and had documented decision regarding re‐transplantation (80.0% vs. 58.0%, p = 0.006). No difference was noted in the comparison of any clinical or biochemical parameters. More patients seen in the LCTC lost their kidney allograft (HR: 2.09, 95%CI: 1.17–3.72, p = 0.013) but patient survival was equivalent (p = 0.343). Conclusion Our data suggest the management of RFKTs within LCTCs can focus attention on renal replacement therapy planning and counselling, but further work is warranted to investigate for any benefit in hard outcomes such as survival.

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Association between continuity of care in general practice and hospital admissions for ambulatory care sensitive conditions: cross sectional study of routinely collected, person level data

Abstract: ObjeCtiveTo assess whether continuity of care with a general practitioner is associated with hospital admissions for ambulatory care sensitive conditions for older patients.

Cited by 330 publications

References 28 publications

Continuity of Primary Care and Emergency Hospital Admissions Among Older Patients in England

Continuity of Primary Care and Emergency Hospital Admissions Among Older Patients in England

Virtuelle Behandlernetzwerke

Development and evaluation of dedicated low clearance transplant clinics for patients with failing kidney transplants

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