Visiting the Same PCP Linked to Fewer Hospital Admissions

Recent research in The BMJ found that older patients who visited the same primary care provider over an extended period of time were less likely to be admitted to the hospital for certain conditions (BMJ. 2017;356:j84).

“Health care systems around the world are facing increases in unplanned hospital admissions,” Isaac Barker, MSc,a data analyst at the Health Foundation in London, and colleagues wrote. “These admissions are often undesirable for patients, disruptive of elective care, and costly, so their prevention has become a priority. Although timely access is an important goal for high quality healthcare, continuity of care is associated with patient satisfaction, as well as quality of life for patients living with long term conditions.”

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In order to determine the affect of long-term PCP utilization with avoidable hospital admissions, the researchers studied 230,472 patients aged 62 to 82 years who visited the same PCP at least twice between April 2011 and March 2013. They studied the linked primary and hospital care records for patients at 200 general practices in England.

Study results showed that higher continuity of care among study participants was linked to fewer avoidable hospital admissions. Patients with higher continuity of care had 12.49% fewer hospitalizations compared to patients with lower continuity of care. The researchers found that each 0.2 increase in the provider of care index measuring continuity of care was associated with a 6.22% reduction in admissions.

The researchers also found that heavy users of primary care (those who visited 18 in more times over the study period) had an increased risk for avoidable hospital admissions—but also had the lowest continuity of care index scores of any subgroup.

Mr Barker and colleagues also noted that continuity of care tended to be lower among larger provider networks.

“Continuity of care aligns closely with the reasons many people chose to work in general practice, is important to patients, correlates with outcomes, and shows variability between general practices,” Mr Barker and colleagues concluded. “Continuity of care is also associated with avoidable hospital admissions. Thus initiatives that improve the continuity of care have the potential to improve the quality of healthcare while reducing cost, both fundamental aims of health care systems.”

In a related editorial, Peter Tammes, PhD, a senior research associate, and Chris Salisbury, MD, a professor of primary health care, both of the Centre for Academic Primary Care at the NIHR School for Primary Care Research at the School of Social and Community Medicine, in Bristol, United Kingdom, stated that the study by Mr Barker and colleagues has important implications for clinicians, patients, and policy makers and builds upon the established research on continuity of care. They noted that findings related to larger provider networks were particularly significant.

“A primary care system that is increasingly fragmented, in which neither patients nor doctors feel strongly connected to their local general practice, provides the setting for patients to choose to attend an emergency department instead,” Tammes and Salisbury wrote. “This is compounded by difficulties in accessing general practices, which are at least as overwhelmed as emergency departments by rising demand.” —David Costill