Primary Care and Specialty Providers

Abstract

Regardless of the predominant provider's specialty, greater continuity was associated with less use of high-cost services and lower expenditures for these services.

Effect of continuity of care on health-related quality of life in adult patients with hypertension: a cohort study in China

“…Most of the previous studies used claims data from health insurance reimbursement databases [3–6, 11, 42]. Moreover, the outcomes of these studies focused on health resource utilization (hospitalizations and emergency department visits) and healthcare expenses.…”

“…The effects of continuity of care have been debated in previous studies because some have concluded that continuity of care is associated with fewer hospitalizations, emergency department visits, and hospital admissions [3–7]; low pharmaceutical expenditures and healthcare expenses [5, 8–10]; decreased mortality rates [11, 12]; fewer duplicated medications [13]; improved medication adherence [14]; and patient satisfaction [15–18]. However, others insist that high continuity of care may lead to the purchase of more drugs overall and that the effects on HRQoL are unclear; thus, these should be further examined [19, 20].…”

Are Two Heads Better Than One or Do Too Many Cooks Spoil the Broth? The Trade‐Off between Physician Division of Labor and Patient Continuity of Care for Older Adults with Complex Chronic Conditions

“…Many studies focus solely on care delivered by PCPs (Wasson 1984;Menec et al 2006;Wolinsky et al 2010;Katz, McCoy, and Vaughan-Sarrazin 2015), while those that allow for inclusion of specialists do not test for a separate effect (Weiss and Blustein 1996;Gill and Mainous 1998;Nyweide et al 2013;Hussey et al 2014;Romano, Segal, and Pollack 2015). Only 1 of the 13 identified studies tests for any separate specialist effect, and it finds that effect to be beneficial for reducing inpatient and ED utilization but it does not address health outcomes or distinguish between disease-relevant and other types of specialists (Romaire et al 2014). The prior research on specialist involvement in chronic illness care is mixed.…”

“…A line of research stretching back to the 1980s finds beneficial associations between higher COC and lower probability of inpatient and/or emergency department (ED) utilization (van Walraven et al 2010). However, more recently, a study of Medicare beneficiaries found increased incidence of ambulatory care-sensitive (ACS) hospitalization for those with higher COC (Romaire et al 2014).…”

“…Despite this reliance on the role of COC from a conceptual standpoint, the empirical evidence supporting it is limited. Since 1984, there have been only 13 studies directly examining the effects of COC on process and outcome measures believed to reflect ambulatory health system performance among older adults (Wasson 1984;Weiss and Blustein 1996;Menec et al 2006;Knight et al 2009;Wolinsky et al 2010Wolinsky et al , 2011aNyweide et al 2013;Hussey et al 2014;Romaire et al 2014;Bayliss et al 2015;Katz, McCoy, and Vaughan-Sarrazin 2015;Romano, Segal, and Pollack 2015). Few, if any, examine health outcomes and the underlying process mechanisms simultaneously in their study population.…”