Continuity of care in primary care and association with survival in older people: a 17-year prospective cohort study

• Published in: British journal of general practice 2016-08, Vol.66 (649), p.e531-e539
• Main Authors: Maarsingh, Otto R, Henry, Ykeda, van de Ven, Peter M, Deeg, Dorly Jh
• Format: Article
• Language: English
• Subjects: Aged; Chronic Disease - mortality; Continuity of Patient Care - standards; Female; Humans; Longitudinal Studies; Male; Middle Aged; Netherlands; Physician-Patient Relations; Primary Health Care - standards; Proportional Hazards Models; Prospective Studies; Survival Analysis; Time Factors
• ISSN: 0960-1643; 1478-5242
• DOI: 10.3399/bjgp16X686101

Although continuity of care is a widely accepted core principle of primary care, the evidence about its benefits is still weak. To investigate whether continuity of care in general practice is associated with better survival in older people. Data were derived from the Longitudinal Aging Study Amsterdam, an ongoing cohort study in older people in the Netherlands. The study sample consisted of 1712 older adults aged ≥60 years, with 3-year follow-up cycles up to 17 years (1992-2009), and mortality follow-up until 2013. Continuity of care was defined as the duration of the ongoing therapeutic relationship between patient and GP. The Herfindahl-Hirschman Index was used to calculate the continuity of care (COC). A COC index value of 1 represented maximum continuity. COC index values 0-0.500) showed significantly greater mortality than those in the maximum COC category (hazard ratio (HR) = 1.20, 95% CI = 1.01 to 1.42). There were no confounders that affected this HR. This study demonstrates that low continuity of care in general practice is associated with a higher risk of mortality, strengthening the case for encouragement of continuity of care.