Association between continuity of care in Swedish primary care and emergency services utilisation: a population-based cross-sectional study
Open accessAbstract
OBJECTIVE: The primary objective of this study was to determine the association between longitudinal continuity of care (CoC) in Swedish primary care (PC) and emergency services (ES) utilisation. STUDY DESIGN: A cross-sectional analysis of longitudinal population data. SETTING: PC centres, out-of-hours PC facilities and emergency departments (EDs) in Blekinge County in southern Sweden. SUBJECTS: People of all ages who lived in Blekinge County and who had made two or more visits per year to a general practitioner (GP) during office hours from 1 January 2012 to 31 December 2014. MAIN OUTCOME MEASURE: ES utilisation. RESULTS: Eight-thousand one-hundred and eighty-five people were included in the study. CoC was quantified using three different indices-Usual Provider of Care index (UPC), Continuity of Care index (CoCI), and Sequential Continuity index (SECON). The CoC that the PC centres could offer their enrolled patients varied significantly between the different centres, ranging from 0.23-0.57 for UPC, 0.12-0.43 for CoCI, and 0.25-0.52 for SECON. Association between the three CoC indices and ES utilisation was computed as an incidence rate ratio which ranged between 0.50 and 0.59. CONCLUSION: Longitudinal CoC was shown to have a negative association with ES utilisation. The association was significant and of a magnitude that implies clinical relevance. Computed incidence rate ratios suggest that patients with the lowest CoC had twice as many ES visits compared to patients with the highest CoC.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Increased continuity of care, particularly with a family physician, is associated with decreased hospitalizations, fewer emergency visits, more preventive care, improved patient satisfaction, safer prescribing, lower rates of major adverse events and reduced mortality.
“In addition, increased continuity of care, particularly with a family physician, is associated with decreased hospitalizations, fewer emergency visits, more preventive care, improved patient satisfaction, safer prescribing, lower rates of major adverse events and reduced mortality [11–17].”
From Improved access to and continuity of primary care after attachment to a family physician: longitudinal cohort study on centralized waiting lists for unattached patients in Quebec, Canada (2022) · cites this paper as [13]
The Introduction (page not specified) reports that higher continuity of care is associated with fewer emergency-department visits, and the study examines continuity across GP visits. Its discussion of preventive measures defines continuity of care; it does not show increased preventive care. The paper does not establish the claimed associations with hospitalizations, patient satisfaction, safer prescribing, major adverse events, or reduced mortality. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Continuity of care: a multidisciplinary review
Haggerty, J. L., Reid, R. J., Freeman, G. K., Starfield, B. H., Adair, C. E., & McKendry, R. (2003) · BMJ · doi:10.1136/bmj.327.7425.1219 · Cited by 2,374 · see citing works
Interpersonal Continuity of Care and Care Outcomes: A Critical Review
Saultz, J. W. (2005) · The Annals of Family Medicine · doi:10.1370/afm.285 · Cited by 613 · see citing works
Defining and Measuring Interpersonal Continuity of Care
Saultz, J. W. (2003) · The Annals of Family Medicine · doi:10.1370/afm.23 · Cited by 588 · see citing works
Wehman, P. (2002) · Focus on Autism and Other Developmental Disabilities · doi:10.1177/10883576020170040101 · Cited by 401 · see citing works
Continuity and the Costs of Care for Chronic Disease
Hussey, P. S., Schneider, E. C., Rudin, R. S., Fox, D. S., Lai, J., & Pollack, C. E. (2014) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2014.245 · Cited by 394 · see citing works
Indices for Continuity of Care: A Systematic Review of the Literature
Jee, S. H., & Cabana, M. D. (2006) · Medical Care Research and Review · doi:10.1177/1077558705285294 · Cited by 348 · see citing works
Primary Care: America's Health in a New Era
Hunt, V. R. (1997) · The Journal of the American Board of Family Practice/The journal of the American Board of Family Practice · doi:10.3122/jabfm.10.5.383 · Cited by 296 · see citing works
Continuity of primary care and emergency department utilization among elderly people
Ionescu-Ittu, R., McCusker, J., Ciampi, A., Vadeboncoeur, A.-M., Roberge, D., Larouche, D., Verdon, J., & Pineault, R. (2007) · Canadian Medical Association Journal · doi:10.1503/cmaj.061615 · Cited by 290 · see citing works
An exploration of the value of the personal doctor-patient relationship in general practice.
(2001) · Europe PMC (PubMed Central) · Cited by 195 · see citing works
The concept and measurement of continuity in primary care.
Rogers, J., & Curtis, P. (1980) · American Journal of Public Health · doi:10.2105/ajph.70.2.122 · Cited by 162 · see citing works
A Longitudinal Examination of Continuity of Care and Avoidable Hospitalization
Cheng, S., Chen, C., & Hou, Y.-F. (2010) · Archives of Internal Medicine · doi:10.1001/archinternmed.2010.340 · Cited by 132 · see citing works
Dreiher, J., Comaneshter, D. S., Rosenbluth, Y., Battat, E., Bitterman, H., & Cohen, A. D. (2012) · Israel Journal of Health Policy Research · doi:10.1186/2045-4015-1-21 · Cited by 120 · see citing works
How should continuity of care in primary health care be assessed?
Salisbury, C., Sampson, F. C., Ridd, M. J., et al. (2009) · British Journal of General Practice · doi:10.3399/bjgp09x420257 · Cited by 118 · see citing works
Does Continuity of Care Matter in a Universally Insured Population?
Menec, V. H., Sirski, M., & Attawar, D. (2005) · Health Services Research · doi:10.1111/j.1475-6773.2005.0p364.x · Cited by 110 · see citing works
Does continuity of care matter in a universally insured population?
Menec, V. H., Sirski, M., & Attawar, D. (2005) · PubMed · doi:10.1111/j.1475-6773.2005.00363.x · Cited by 96 · see citing works
Hong, J. S., Kang, H. C., & Kim, J. (2010) · Journal of Korean Medical Science · doi:10.3346/jkms.2010.25.9.1259 · Cited by 93 · see citing works
Factors predicting patient use of the emergency department: a retrospective cohort study
McCusker, J., Tousignant, P., Silva, R. B. D., Ciampi, A., Lévesque, J.-F., Vadeboncoeur, A., & Sanche, S. (2012) · Canadian Medical Association Journal · doi:10.1503/cmaj.111069 · Cited by 87 · see citing works
Attachment in the doctor–patient relationship in general practice: A qualitative study
Frederiksen, H. B., Kragstrup, J., & Dehlholm-Lambertsen, B. (2010) · Scandinavian Journal of Primary Health Care · doi:10.3109/02813432.2010.505447 · Cited by 86 · see citing works
KNIGHT, J. C., Dowden, J. J., Worrall, G. J., et al. (2009) · Population Health Management · doi:10.1089/pop.2008.0020 · Cited by 80 · see citing works
Better continuity of care reduces costs for diabetic patients.
Chen, C.-C., & Chen, S.-H. (2011) · PubMed · Cited by 78 · see citing works
Starfield, B. H. (1980) · American Journal of Public Health · doi:10.2105/ajph.70.2.117 · Cited by 76 · see citing works
Continuity of care and family medicine: definition, determinants, and relationship to outcome.
Wall, E. M. (1981) · PubMed · Cited by 68 · see citing works
Association Between Infant Continuity of Care and Pediatric Emergency Department Utilization
Brousseau, D. C., Meurer, J., Isenberg, M. L., et al. (2004) · PEDIATRICS · doi:10.1542/peds.113.4.738 · Cited by 66 · see citing works
Does continuity of care matter in a health care system that lacks referral arrangements?
Cheng, S., Hou, Y., & Chen, C.-C. (2010) · Health Policy and Planning · doi:10.1093/heapol/czq035 · Cited by 50 · see citing works
Personal continuity of care in Norwegian general practice: A national cross-sectional study
Hetlevik, Ø., & Gjesdal, S. (2012) · Scandinavian Journal of Primary Health Care · doi:10.3109/02813432.2012.735554 · Cited by 35 · see citing works
(2013) · PubMed · Cited by 32 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Sandvik, H., Hetlevik, Ø., Blinkenberg, J., & Hunskaar, S. (2022) · British Journal of General Practice · doi:10.3399/bjgp.2021.0340 · Cited by 333 · see citing works
Smithman, M. A., Haggerty, J., Gaboury, I., & Breton, M. (2022) · BMC Primary Care · doi:10.1186/s12875-022-01850-4 · Cited by 25 · see citing works
- Authors
- Kohnke, H., & Zielinski, A.
- Affiliations
- Region Blekinge (SE)
- Lyckeby Primary Health Care Centre and Blekinge Centre of Competence, Lyckeby, Sweden
- Corresponding author
- Kohnke, Hannes
- Venue
- Scandinavian Journal of Primary Health Care
- Publisher
- Informa UK Limited
- Published
- 2017-04-03
- Volume
- 35
- Issue
- 2
- Pages
- 113-119
- ISSN
- 0281-3432 (ISSN-L)
- 1502-7724
- PMC
- PMC5499310
- OpenAlex
- W2621681176
- Cited by
- 58
- References
- 26
- Citations by year
- 2026: 3 · 2025: 11 · 2024: 10 · 2023: 9 · 2022: 7 · 2021: 5 · 2020: 6 · 2019: 5 · 2018: 2
- FWCI
- 5.76
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Scandinavian Journal of Primary Health Care (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- the Scientific council in Karlskrona
- Topics
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Healthcare Systems and Technology
- Keywords
- continuity of care, emergency department utilization, primary care, usual provider of care, continuity of care index, out-of-hours care, general practitioners, Blekinge County
- MeSH terms
- Adolescent, Adult, Aged, Continuity of Patient Care, Cross-Sectional Studies, Emergency Medical Services, Female, Humans, Longitudinal Studies, Male, Middle Aged, Regression Analysis, Sweden, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
