Continuity of primary care and emergency department utilization among elderly people

Abstract

Background: People aged 65 years or more represent a growing group of emergency department users. We investigated whether characteristics of primary care (accessibility and continuity) are associated with emergency department use by elderly people in both urban and rural areas. Methods:We conducted a cross-sectional study using information for a random sample of 95 173 people aged 65 years or more drawn from provincial administrative databases in Quebec for 2000 and 2001. We obtained data on the patients' age, sex, comorbidity, rate of emergency department use (number of days on which a visit was made to an amergency department per 1000 days at risk [i.e., alive and not in hospital] during the 2-year study period), use of hospital and ambulatory physician services, residence (urban v. rural), socioeconomic status, access (physician: population ratio, presence of primary physician) and continuity of primary care. Results:After adjusting for age, sex and comorbidity, we found that an increased rate of emergency department use was associated with lack of a primary physician (adjusted rate ratio [RR] 1.45, 95% confidence interval [CI] 1.41-1.49) and low or medium (v. high) levels of continuity of care with a primary physician (adjusted RR 1.46, 95% CI 1.44-1.48, and 1.27, 95% CI 1.25-1.29, respectively). Other significant predictors of increased use of emergency department services were residence in a rural area, low socioeconomic status and residence in a region with a higher physician:population ratio. Among the patients who had a primary physician, continuity of care had a stronger protective effect in urban than in rural areas.Interpretation: Having a primary physician and greater continuity of care with this physician are factors associated with decreased emergency department use by elderly people, particularly those living in urban areas. Abstract CMAJ 2007;177(11):1362-8From the

Cross-sectional survey of older patients’ views regarding multidisciplinary care for chronic conditions in general practice

“…At the same time, the results again demonstrate the importance to older patients of interpersonal continuity of care with their GP (Nutting et al 2003). As interpersonal continuity is also associated with better outcomes for older patients (Ionescu-Ittu et al 2007;Worrall and Knight 2011), the findings of this study lend support to ensuring that this continuity is not lost in the midst of health care reform (Bonney and Farmer 2010). The medical aspects of CDM, such as prescribing, investigation and referral, are outside of the scope of PNs at the moment.…”

After-Hours Care in Suburban Canada

“…When viewed in the context of prior Canadian research, [9][10][11][12] our findings suggest that the provision of after-hours care in a physician office setting provides additional primary care services in an appropriate and cost-effective manner. In fact, AHC care may reduce inappropriate ED use, decrease reutilization rates, and ultimately promote greater satisfaction with care for care seekers.…”

“…7 The utilization of EDs for nonurgent medical conditions contributes to excessive burden on hospitals and can result in longer wait times for medical intervention, regardless of severity. [8][9][10] Patients seeking care for nonacute conditions have been confirmed as an important determinant of ED overcrowding. Almost one quarter of EDs report a large volume of nonacute patients as a "major or severe" cause of ED overcrowding.…”

“…10 Additionally, the treatment of minor medical conditions in an ED setting is associated with higher costs per treatment, increased reutilization of health services, and a decrease in the continuity of care delivered. 3,4,9,11 Limited access to outpatient physician services leads many individuals with nonurgent medical conditions to seek care in local EDs. [8][9][10] There is a need for more studies focusing on interventions to reduce ED overcrowding.…”

“…3,4,9,11 Limited access to outpatient physician services leads many individuals with nonurgent medical conditions to seek care in local EDs. [8][9][10] There is a need for more studies focusing on interventions to reduce ED overcrowding. 12 Previous research has focused on ED-specific interventions, while little attention has been paid to the influence of services delivered outside the ED setting.…”