Association between continuity of provider-adjusted regularity of general practitioner contact and unplanned diabetes-related hospitalisation: a data linkage study in New South Wales, Australia, using the 45 and Up Study cohort

Abstract

ObjectiveTo assess the association between continuity of provider-adjusted regularity of general practitioner (GP) contact and unplanned diabetes-related hospitalisation or emergency department (ED) presentation.DesignCross-sectional study.SettingIndividual-level linked self-report and administrative health service data from New South Wales, Australia.Participants27 409 survey respondents aged ≥45 years with a prior history of diabetes and at least three GP contacts between 1 July 2009 and 30 June 2015.Main outcome measuresUnplanned diabetes-related hospitalisations or ED presentations, associated costs and bed days.ResultsTwenty-one per cent of respondents had an unplanned diabetes-related hospitalisation or ED presentation. Increasing regularity of GP contact was associated with a lower probability of hospitalisation or ED presentation (19.9% for highest quintile, 23.5% for the lowest quintile). Conditional on having an event, there was a small decrease in the number of hospitalisations or ED presentations for the low (−6%) and moderate regularity quintiles (−8%), a reduction in bed days (ranging from −30 to −44%) and a reduction in average cost of between −23% and −41%, all relative to the lowest quintile. When probability of diabetes-related hospitalisation or ED presentation was included, only the inverse association with cost remained significant (mean of $A3798 to $A6350 less per individual, compared with the lowest regularity quintile). Importantly, continuity of provider did not significantly modify the effect of GP regularity for any outcome.ConclusionsHigher regularity of GP contact—that is more evenly dispersed, not necessarily more frequent care—has the potential to reduce secondary healthcare costs and, conditional on having an event, the time spent in hospital, irrespective of continuity of provider. These findings argue for the advocacy of regular care, as distinct from solely continuity of provider, when designing policy and financial incentives for GP-led primary care.

The association between general practitioner regularity of care and ‘high use’ hospitalisation

“…Unlike other studies evaluating rates or cost of hospitalisation [ 12 , 16 , 20 , 44 , 47 ] we did not find a strong inverse association across increasing regularity levels. This may have been due to the outcomes we evaluated having a different relationship with regularity.…”

“…One of the issues in assessing regularity is in disentangling its effects from those of continuity of provider and frequency of care. Again, among a cohort of people with diabetes, higher regularity (adjusted for continuity of provider and frequency of GP attendance) showed an association with lower costs for unplanned hospitalisation, suggesting that regularity is a discrete facet of continuity of care [ 20 ]. Previous analyses have suggested that regular primary care provision may also be associated with fewer readmissions [ 21 – 24 ].…”

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

“…As continuity of care is seldom applied in EDs when compared with office-hours primary care [4][5][6], organising distribution of work differently between these two health care providers might enhance this continuity [4,16]. It is not only the continuity of care by certain individual care providers which matters but also provider-adjusted regularity of the contacts [17]. To support this view, a large global study (34 countries during the years 2011 to 2013) found that adequate access to primary care decreased ED visits [18].…”

Effect Modification of Multimorbidity on the Association Between Regularity of General Practitioner Contacts and Potentially Avoidable Hospitalisations

“…6,7 Various aspects of primary health care utilisation can be measured using a variety of tools such as frequency of GP contacts, continuity of provider and regularity of GP contacts. [8][9][10][11][12] Regularity of GP contacts captures the dispersion of GP contacts, i.e. the extent of the variation in time intervals between contacts with a GP.…”

“…Regularity has therefore been suggested as a suitable target for health policy interventions aiming at reducing avoidable hospitalisations and controlling healthcare resource use. 12,16 Although literature highlights the benefit of regular contacts with GPs among certain chronic conditions, limited evidence exists on whether the effect of regularity on hospitalisation may be modified by multimorbidity. Given the high burden of multimorbidity, a better understanding of how multimorbidity may modify the relationship between regularity of GP contact and the risk of hospitalisation would inform whether current primary healthcare delivery models need to be reorganised for people with certain levels of multimorbidity.…”