Associations between continuity of primary and specialty physician care and use of hospital-based care among community-dwelling older adults with complex care needs
Open accessAbstract
OBJECTIVE: While research suggests that higher continuity of primary and specialty physician care can improve patient outcomes, their effects have rarely been examined and compared concurrently. We investigated associations between continuity of primary and specialty physician care and emergency department visits and hospital admissions among community-dwelling older adults with complex care needs. METHODS: We conducted a retrospective cohort study of home care patients in Ontario, Canada, from October 2014 to September 2016. We measured continuity of primary and specialty physician care over the two years prior to a home care assessment and categorized them into low, medium, and high groups using terciles of the distribution. We used Cox regression models to concurrently test the associations between continuity of primary and specialty care and risk of an emergency department visit and hospital admission within six months of assessment, controlling for potential confounders. We examined interactions between continuity of care and count of chronic conditions, count of physician specialties seen, functional impairment, and cognitive impairment. RESULTS: Of 178,686 participants, 49% had an emergency department visit during follow-up and 27% had a hospital admission. High vs. low continuity of primary care was associated with a reduced risk of an emergency department visit (HR = 0.90 (0.89-0.92)) as was continuity of specialty care (HR = 0.93 (0.91-0.95)). High vs. low continuity of primary care was associated also with a reduced risk of a hospital admission (HR = 0.94 (0.92-0.96)) as was continuity of specialty care (HR = 0.92 (0.90-0.94)). The effect of continuity of specialty care was moderately stronger among patients who saw four or more physician specialties. CONCLUSION: Higher continuity of primary physician and specialty physician care had independent, protective effects of similar magnitude against emergency department use and hospital admissions. Improving continuity of specialty care should be a priority alongside improving continuity of primary care in complex, older adult populations with significant specialist use.
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Relational continuity contributes to a lower risk of Emergency Department presentation and hospital admission.
“Relational continuity contributes to a lower risk of Emergency Department presentation and hospital admission [46], improvement in the quality of home health care [47], and it is essential to collaboration between formal and informal care providers [48].”
From Towards defining quality in home care for persons living with dementia (2022) · cites this paper as [46]
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- Authors
- Jones, A., Bronskill, S. E., Seow, H., Junek, M., Feeny, D., & Costa, A. P.
- Affiliations
- McMaster University (CA)
- University of Toronto (CA)
- Corresponding author
- Jones, Aaron
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2020-06-19
- Volume
- 15
- Issue
- 6
- Pages
- e0234205
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC7304563
- OpenAlex
- W3036726826
- Cited by
- 37
- References
- 48
- Citations by year
- 2026: 8 · 2025: 3 · 2024: 5 · 2023: 9 · 2022: 9 · 2021: 3
- FWCI
- 5.48
- Type
- journal article
- Language
- en
- Update notices
- correction (2021-10-12)
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Institute of Health Services and Policy Research (148933)
- Topics
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Keywords
- continuity of care, primary care, specialist care, emergency department visits, hospitalization, community-dwelling older adults, complex care needs, home care, chronic disease, functional disability, cognitive impairment
- MeSH terms
- Aged, Aged, 80 and over, Chronic Disease, Continuity of Patient Care, Emergency Service, Hospital, Female, Home Care Services, Hospitalization, Humans, Male, Ontario, Primary Health Care, Retrospective Studies, Specialization, Cohort Studies
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