Continuity of care in primary care and association with survival in older people: a 17-year prospective cohort study

Abstract

BackgroundAlthough continuity of care is a widely accepted core principle of primary care, the evidence about its benefits is still weak. AimTo investigate whether continuity of care in general practice is associated with better survival in older people. Design and settingData were derived from the Longitudinal Aging Study Amsterdam, an ongoing cohort study in older people in the Netherlands. The study sample consisted of 1712 older adults aged ≥60 years, with 3-year follow-up cycles up to 17 years (1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009), and mortality follow-up until 2013. MethodContinuity of care was defined as the duration of the ongoing therapeutic relationship between patient and GP. The Herfindahl-Hirschman Index was used to calculate the continuity of care (COC). A COC index value of 1 represented maximum continuity. COC index values <1 were divided into tertiles, with a fourth category for participants with maximum COC. Cox regression analysis was used to investigate the association between COC and survival time. ResultsSeven hundred and forty-two participants (43.3%) reported a maximum COC. Among the 759 participants surviving 17 years, 251 (33.1%) still had the same GP. The lowest COC category (index >0-0.500) showed significantly greater mortality than those in the maximum COC category (hazard ratio (HR) = 1.20, 95% CI = 1.01 to 1.42). There were no confounders that affected this HR. ConclusionThis study demonstrates that low continuity of care in general practice is associated with a higher risk of mortality, strengthening the case for encouragement of continuity of care.

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