Continuity of Primary Care and Hospitalizations

By February 9, 2017Commentary

One of our new articles of faith for health care is that “better” primary care will lead to less spending on specialists and hospitals.  A study in the British Medical Journal examines whether sticking with primary care doctor over a longer period of time helps reduce hospitalizations.   (BMJ Article)   The reason hospitalizations might be limited is that a certain subset of them is viewed as resulting from lack of or ineffective primary care.  Better primary care would prevent exacerbation of existing health conditions that might lead to an acute stay.  So the authors used data from 200 general practices in England from April 2011 to March 2013 to test the association between continuity of primary care, with continuity being a marker for “better” primary care, and avoidable ambulatory care-sensitive hospitalizations.   Ambulatory care-sensitive hospitalizations are those relating to chronic diseases or acute conditions which with proper management should not result in inpatient treatment.  In this study, 22 such conditions were identified and tested.  Continuity of use of the same primary care provider could be reflective of a stronger relationship with the patient, with better understanding of all the patient’s health issues and with more coordination of all the health care services the patient receives.

The patients studied were aged 62 to 82, due to their higher overall rates of inpatient facility use.  EMR data on patient visits for the 200 primary care practices was linked to hospital episode statistics.  Continuity of primary care was measured by the usual provider index, which takes the proportion of visits by the most frequently seen physician compared to all physician visits.  Low continuity was defined as a score on this index of 0 to .4, medium continuity was .4 to .7 and high continuity was .7 to 1.  Patient characteristics were also factored in.  There were about 52,500 patients in the low continuity group, 96,000 in the medium one and 81,000 had high continuity scores.  About 10% of all patients had an ambulatory care-sensitive admission in the study period.  Males, older patients, those in lower socioeconomic strata, patients who had more use of specialists, and patients who had more long-term health conditions tended to have more of these admissions.  After adjustment, patients with higher continuity scores still experienced about 12.5% fewer ambulatory care-sensitive admissions and patients with medium continuity scores had fewer such admissions than did patients with low scores.  So the study supports the notion that seeing the same primary care doctor over an extended time might help reduce hospitalizations.

Kevin Roche

Author Kevin Roche

The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry through Roche Consulting, LLC. Mr. Roche is available to assist health care companies through consulting arrangements and may be reached at khroche@healthy-skeptic.com.

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