Continuity of care in general practice reduces elderly hospitalisations

Better continuity of care in general practice is associated with a lower rate of hospital admissions for certain conditions in the elderly, British researchers have reported.

Their study of the linked primary and secondary care records of 230,472 individuals aged 62 to 82 years showed that patients with a higher continuity of care tended to have fewer hospital admissions for ambulatory care-sensitive conditions such as asthma, influenza, pneumonia and gangrene.

Continuity of care was assessed using the usual provider of care index, defined as the proportion of contacts during the study that were with the most frequently seen GP. The average usual provider of care index score was 0.61. Overall, among individuals who had at least two contacts with a GP over the two-year study period, a 0.2 increase in the usual provider of care index score translated to a 6.22% reduction in admissions to hospital for those conditions.

According to the study findings, published in the BMJ, individuals classed as having a high continuity of care had 12.4% fewer admissions to hospital compared with those with low continuity of care. The researchers also noted that individuals with the highest levels of general practice utilisation also tended to have lower continuity of care, as well as experiencing more hospital admissions.

Continuity of care was significantly associated with practice size: in practices with one to three fulltime equivalent GPs, nearly half the patients experienced high continuity of care, compared with 30.7% of patients in practices with seven or more fulltime equivalent GPs.

‘This study motivates a renewed focus on promoting continuity of care, and it suggests that continuity is an important consideration when designing approaches to reduce hospital admissions,’ the researchers wrote.

Commenting on the study, RACGP President Dr Bastian Seidel said the findings tie in with other research suggesting that better continuity of care is also associated with reduced mortality and reduced readmission rates after hospital discharge.

‘There is a strong evidence base indicating that seeing the same GP and having increasing continuity of care is not only improving health outcomes but also saving the health system a fair bit of money,’ Dr Seidel told Medicine Today.

‘The RACGP estimates that unnecessary hospital admissions are costing the taxpayer $2 billion every year, so it’s a significant amount of funds that could be redirected to general practice to improve continuity of care.’

Dr Seidel said continuity of care could be improved with measures such as supporting smaller general practices and providing practice incentive payments to encourage continuity of care.