Seeing the same family doctor keeps older patients out of hospital

Older patients who see the same primary care physician over time experience fewer avoidable admissions to hospital for certain conditions, according to a U.K. study.In their paper in the BMJ, data analyst Isaac Barker and colleagues with the Health Foundation, a London-based independent charity, noted many health-care systems have focused on improving access to primary care by, for example, extending hours or introducing remote care, “but this might have the unintended effect of reducing continuity of care.”The researchers analyzed records from 200 general practices participating in a database in England. They focused on 230,472 patients between 62 and 82 years of age who had at least two contacts with a general practitioner between April 2011 and March 2013.The outcome of interest was the number of hospital admissions for 22 “ambulatory care sensitive conditions” (i.e., those considered manageable in primary care) per patient during the study period. Continuity of care was assessed using the “usual provider of care index,” defined as the proportion of contacts during the study period that were with the most frequently seen general practitioner.On average, the usual provider of care index score was 0.61. Continuity of care was lower among practices with more doctors (average score 0.59 in large practices versus 0.70 in small practices).Higher continuity of care was associated with fewer admissions for ambulatory care sensitive conditions. After controlling for demographic and clinical patient characteristics, an increase in the usual provider of care index of 0.2 for all patients reduced these admissions by 6.22%.There was greater evidence for an association among patients who were heavy users of primary care, the researchers noted. Heavy users also experienced more admissions for ambulatory care sensitive conditions than other patients (0.36 admissions per patient for those with 18 or more contacts with a general practitioner, compared with 0.04 admissions per patient for those with two to four contacts).“Strategies that improve the continuity of care in general practice may reduce secondary care costs, particularly for the heaviest users of health care,” Barker and his colleagues concluded. “Promoting continuity might also improve the experience of patients and those working in general practice.”In a related editorial, two primary care researchers from the University of Bristol in England called the findings “highly relevant internationally” because most developed countries have aging populations with a high prevalence of multimorbidity.“We hypothesize that seeing the same doctor . . . builds trust and a sense of mutual responsibility between patients and GPs. This means that patients are more likely to seek the advice of their usual doctor rather than attend elsewhere. It also means that doctors have a greater sense of responsibility in ensuring that patients are well managed and professional pride in not referring patients to hospital unnecessarily,” the editorialists wrote. “A primary care system that is increasingly fragmented, in which neither patients nor doctors feel strongly connected to their local general practice, provides the setting for patients to choose to attend an emergency department instead. This is compounded by difficulties in accessing general practices, which are at least as overwhelmed as emergency departments by rising demand.”

Seeing the same family doctor keeps older patients out of hospital

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