Primary care continuity and potentially avoidable hospitalization in persons with dementia
Abstract
BACKGROUND/OBJECTIVE: To measure the association between high primary care continuity and potentially avoidable hospitalization in community-dwelling persons with dementia. Our hypothesis was that high primary care continuity is associated with fewer potentially avoidable hospitalizations. DESIGN: Population-based retrospective cohort (2012-2016), with inverse probability of treatment weighting using the propensity score. SETTING: Quebec (Canada) health administrative database, recording most primary, secondary and tertiary care services provided via the public universal health insurance system. PARTICIPANTS: Population-based sample of 22,060 community-dwelling 65 + persons with dementia on March 31st, 2015, with at least two primary care visits in the preceding year (mean age 81 years, 60% female). Participants were followed for 1 year, or until death or long-term care admission. EXPOSURE: High primary care continuity on March 31st, 2015, i.e., having had every primary care visit with the same primary care physician, during the preceding year. MAIN OUTCOME MEASURES: Primary: Potentially avoidable hospitalization in the follow-up period as defined by ambulatory care sensitive conditions (ACSC) hospitalization (general and older population definitions), 30-day hospital readmission; Secondary: Hospitalization and emergency department visit. RESULTS: Among the 22,060 persons, compared with the persons with low primary care continuity, the 14,515 (65.8%) persons with high primary care continuity had a lower risk of ACSC hospitalization (general population definition) (relative risk reduction 0.82, 95% CI 0.72-0.94), ACSC hospitalization (older population definition) (0.87, 0.79-0.95), 30-day hospital readmission (0.81, 0.72-0.92), hospitalization (0.90, 0.86-0.94), and emergency department visit (0.92, 0.90-0.95). The number needed to treat to prevent one event were, respectively, 118 (69-356), 87 (52-252), 97 (60-247), 23 (17-34), and 29 (21-47). CONCLUSION: Increasing continuity with a primary care physician might be an avenue to reduce potentially avoidable hospitalizations in community-dwelling persons with dementia on a population-wide level.
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Ongoing relationships with general practitioners were associated with lower rates of emergency hospitalization and delirium.
“Ongoing relationships with general practitioners built trust, promoted earlier identification of support needs, and were associated with lower rates of emergency hospitalization and delirium (Delgado et al., 2022; Godard-Sebillotte et al., 2021; Lei et al., 2020; Nguyen et al., 2022; Toles et al., 2022b; Zmora et al., 2021).”
From Mind the gap: a systematic review of barriers, facilitators, and experiences of care transitions for people living with dementia and their informal caregivers. (2026) · cites this paper as Godard-Sebillotte et al., 2021
Ongoing relationships with general practitioners built trust and promoted earlier identification of support needs.
“Ongoing relationships with general practitioners built trust, promoted earlier identification of support needs, and were associated with lower rates of emergency hospitalization and delirium (Delgado et al., 2022; Godard-Sebillotte et al., 2021; Lei et al., 2020; Nguyen et al., 2022; Toles et al., 2022b; Zmora et al., 2021).”
From Mind the gap: a systematic review of barriers, facilitators, and experiences of care transitions for people living with dementia and their informal caregivers. (2026) · cites this paper as Godard-Sebillotte et al., 2021
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Who Provides Home-Based Primary Care to People With Dementia?
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Howard, C., Fernández‐Sanlés, A., Abukar, N., Davis, D. H. J., Goodman, C. M., Gupta, S., Handley, M., Mukadam, N., Riddington, C., Walters, K. R., et al. (2026) · Alzheimer s & Dementia · doi:10.1002/alz.71323
- Authors
- Godard‐Sebillotte, C., Strumpf, E., Sourial, N., Rochette, L., Pelletier, E., & Vedel, I.
- Affiliations
- McGill University (CA)
- Institut National de Santé Publique du Québec (CA)
- Institut national de santé publique du Québec (INSPQ) Montreal Quebec Canada
- Corresponding author
- Godard‐Sebillotte, Claire
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2021-02-26
- Volume
- 69
- Issue
- 5
- Pages
- 1208-1220
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- OpenAlex
- W3130410707
- Cited by
- 50
- References
- 43
- Citations by year
- 2026: 3 · 2025: 14 · 2024: 9 · 2023: 8 · 2022: 14 · 2021: 2
- FWCI
- 9.27
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research
- Fonds de Recherche du Québec - Santé
- Topics
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Keywords
- dementia, primary care continuity, potentially avoidable hospitalizations, ambulatory care sensitive conditions, 30-day readmission, emergency department visits, community-dwelling older adults, continuity of care, health care utilization, number needed to treat, long-term care admission, quality of care, health care access
- MeSH terms
- Aged, Aged, 80 and over, Ambulatory Care, Continuity of Patient Care, Dementia, Emergency Service, Hospital, Female, Health Services Misuse, Hospitalization, Humans, Male, Patient Readmission, Primary Health Care, Quebec, Retrospective Studies, Databases, Factual, Universal Health Insurance, Independent Living, Propensity Score
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