Continuity of primary care matters and should be protected

Tammes, Peter; Salisbury, Chris

doi:10.1136/bmj.j373

Cited by 27 publications

(31 citation statements)

References 7 publications

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“…These findings are consistent with previous studies that found relational continuity to be associated with reduced risk of ACSC admission in a range of different patient groups . Higher continuity of family physician care may reduce the need for hospital care through improved management of physical health, by facilitating familiarity, communication, trust, and quality of relationship between doctor and patient . The results also suggest that the documentation and sharing of information and management plans across physicians within a family practice can have important benefits for both the physical and mental health of people with SMI.…”

Section: Discussionsupporting

confidence: 90%

“…It is valued by patients 9,10 and providers 11 and considered good practice in mental health and family medicine, [12][13][14] reducing fragmentation of care and facilitating better provider-patient relationships. 15 Relational continuity-the longitudinal relationship between a patient and a health care practitioner (or group of practitioners) 16 -is often the focus of efforts to improve continuity. To date, evidence has been mixed on whether relational continuity improves outcomes for people with SMI.…”

Section: Introductionmentioning

confidence: 99%

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Impact of family practice continuity of care on unplanned hospital use for people with serious mental illness

Ride

Kasteridis

Gutacker

et al. 2019

Health Services Research

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Objective To investigate whether continuity of care in family practice reduces unplanned hospital use for people with serious mental illness (SMI). Data Sources Linked administrative data on family practice and hospital utilization by people with SMI in England, 2007‐2014. Study Design This observational cohort study used discrete‐time survival analysis to investigate the relationship between continuity of care in family practice and unplanned hospital use: emergency department (ED) presentations, and unplanned admissions for SMI and ambulatory care‐sensitive conditions (ACSC). The analysis distinguishes between relational continuity and management/ informational continuity (as captured by care plans) and accounts for unobserved confounding by examining deviation from long‐term averages. Data Collection/Extraction Methods Individual‐level family practice administrative data linked to hospital administrative data. Principal Findings Higher relational continuity was associated with 8‐11 percent lower risk of ED presentation and 23‐27 percent lower risk of ACSC admissions. Care plans were associated with 29 percent lower risk of ED presentation, 39 percent lower risk of SMI admissions, and 32 percent lower risk of ACSC admissions. Conclusions Family practice continuity of care can reduce unplanned hospital use for physical and mental health of people with SMI.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Impact of family practice continuity of care on unplanned hospital use for people with serious mental illness

Ride

Kasteridis

Gutacker

et al. 2019

Health Services Research

View full text Add to dashboard Cite

show abstract

“…This finding might be highly relevant for policy makers because of increasing size of elderly populations. 37 Discontinuity of care reduces the opportunity for building trust and mutual responsibility between patients and physicians, which might underlie the increased risk of emergency hospital admission. 37 More qualitative and quantitative research is needed, therefore, to understand the relationship between continuity of care and reasons for admission, and to understand patients' values and experiences of continuity of care.…”

Section: Implications For General Practices and Future Researchmentioning

confidence: 99%

“…37 Discontinuity of care reduces the opportunity for building trust and mutual responsibility between patients and physicians, which might underlie the increased risk of emergency hospital admission. 37 More qualitative and quantitative research is needed, therefore, to understand the relationship between continuity of care and reasons for admission, and to understand patients' values and experiences of continuity of care. 38 Distinguishing between general practitioner-referred emergency hospital admissions and admissions through an emergency department requires a larger data set.…”

Section: Implications For General Practices and Future Researchmentioning

confidence: 99%

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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“…In a linked editorial,2 researchers at the University of Bristol suggested that seeing the same doctor “builds trust and a sense of mutual responsibility between patients and GPs,” while a primary care system that is increasingly fragmented “provides the setting for patients to choose to attend an emergency department instead.”…”

mentioning

confidence: 99%

Seeing same GP is linked to fewer hospital admissions

Torjesen¹

2017

BMJ

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Continuity of primary care matters and should be protected

Abstract: General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available:

Cited by 27 publications

References 7 publications

Impact of family practice continuity of care on unplanned hospital use for people with serious mental illness

Impact of family practice continuity of care on unplanned hospital use for people with serious mental illness

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

Seeing same GP is linked to fewer hospital admissions

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