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Continuity of Primary Care and Emergency Hospital Admissions Among Older Patients in England

Research output: Contribution to journalArticle

Original languageEnglish
Pages (from-to)515-522
Number of pages8
JournalAnnals of Family Medicine
Issue number6
DateAccepted/In press - 5 Jun 2017
DatePublished (current) - 30 Nov 2017


PURPOSE: Secondary health care services have been under considerable pressure in England as attendance rates increase, resulting in longer waiting times and greater demands on staff. This study's aim was to examine the association between continuity of care and risk of emergency hospital admission among older adults.

METHODS: We analyzed records from 10,000 patients aged 65 years and older in 2012 within 297 English general practices obtained from the Clinical Practice Research Datalink and linked with Hospital Episode Statistics. We used the Bice and Boxerman (BB) index and the appointed general practitioner index (last general practitioner consulted before hospitalization) to quantify patient-physician continuity. The BB index was used in a prospective cohort approach to assess impact of continuity on risk of admission. Both indices were used in a separate retrospective nested case-control approach to test the effect of changing physician on the odds of hospital admission in the following 30 days.

RESULTS: In the prospective cohort analysis, the BB index showed a graded, non-significant inverse relationship of continuity of care with risk of emergency hospital admission, although the hazard ratio for patients experiencing least continuity was 2.27 (95% CI, 1.37-3.76) compared with those having complete continuity. In the retrospective nested case-control analysis, we found a graded inverse relationship between continuity of care and emergency hospital admission for both BB and appointed general practitioner indices: for the latter, the odds ratio for those experiencing least continuity was 2.32 (95% CI, 1.48-3.63) relative to those experiencing most continuity.

CONCLUSIONS: Marked discontinuity of care might contribute to increased unplanned hospital admissions among patients aged 65 years and older. Schemes to enhance continuity of care have the potential to reduce hospital admissions.

    Research areas

  • Emergency hospital admission, Continuity of care, Primary care, Family practice, Longitudinal data

    Structured keywords

  • Centre for Surgical Research

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    Rights statement: This is the author accepted manuscript (AAM). The final published version (version of record) is available online via Annals of Family Medicine at Please refer to any applicable terms of use of the publisher.

    Accepted author manuscript, 514 KB, PDF document


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