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

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Continuity of Primary Care and Emergency Hospital Admissions Among Older Patients in England. / Tammes, Peter; Purdy, Sarah; Salisbury, Chris; MacKichan, Fiona; Lasserson, Daniel; Morris, Richard W.

In: Annals of Family Medicine, Vol. 15, No. 6, 30.11.2017, p. 515-522.

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Tammes, Peter ; Purdy, Sarah ; Salisbury, Chris ; MacKichan, Fiona ; Lasserson, Daniel ; Morris, Richard W. / Continuity of Primary Care and Emergency Hospital Admissions Among Older Patients in England. In: Annals of Family Medicine. 2017 ; Vol. 15, No. 6. pp. 515-522.

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@article{fac4a3312c294a8681bf2e0fb9b823d2,
title = "Continuity of Primary Care and Emergency Hospital Admissions Among Older Patients in England",
abstract = "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.",
keywords = "Emergency hospital admission, Continuity of care, Primary care, Family practice, Longitudinal data",
author = "Peter Tammes and Sarah Purdy and Chris Salisbury and Fiona MacKichan and Daniel Lasserson and Morris, {Richard W}",
note = "{\circledC} 2017 Annals of Family Medicine, Inc.",
year = "2017",
month = "11",
day = "30",
doi = "10.1370/afm.2136",
language = "English",
volume = "15",
pages = "515--522",
journal = "Annals of Family Medicine",
issn = "1544-1709",
publisher = "Annals of Family Medicine, Inc",
number = "6",

}

RIS - suitable for import to EndNote

TY - JOUR

T1 - Continuity of Primary Care and Emergency Hospital Admissions Among Older Patients in England

AU - Tammes, Peter

AU - Purdy, Sarah

AU - Salisbury, Chris

AU - MacKichan, Fiona

AU - Lasserson, Daniel

AU - Morris, Richard W

N1 - © 2017 Annals of Family Medicine, Inc.

PY - 2017/11/30

Y1 - 2017/11/30

N2 - 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.

AB - 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.

KW - Emergency hospital admission

KW - Continuity of care

KW - Primary care

KW - Family practice

KW - Longitudinal data

U2 - 10.1370/afm.2136

DO - 10.1370/afm.2136

M3 - Article

VL - 15

SP - 515

EP - 522

JO - Annals of Family Medicine

JF - Annals of Family Medicine

SN - 1544-1709

IS - 6

ER -