Continuity of care halves risk of emergency hospital admission, research suggests

Patients aged over 65 with poor continuity of care in general practice are more than twice as likely to face an emergency hospital admission as patients with high continuity of care, UK research suggests.

Continuity of care helps keep older patients out of hospital (Photo: iStock)

Data from 10,000 patients aged 65 or over from 297 GP practices across England show that older patients who are not able to see the same GP regularly face a significantly increased risk of emergency hospital admission.

One of two techniques for evaluating continuity of care used in the study involved calculating the proportion of visits during the study period - April 2012 to March 2014 - to the GP the patient saw most recently before an emergency hospital admission.

Patients in the lowest quartile for continuity of care on this measure were more than twice as likely to experience an emergency hospital admission as patients in the highest quartile, according to the study published in the Annals of Family Medicine.

Ageing population

With growing numbers of older patients across the UK, the findings could be 'highly relevant for policy makers', the researchers from the University of Bristol's Centre for Academic Primary Care warned.

'Discontinuity of care reduces the opportunity for building trust and mutual responsibility between patients and physicians, which might underlie the increased risk of emergency hospital admission,' they added.

The study's findings echo results of previous research. Findings published in the BMJ earlier this year found that patients seeing the same GP regularly was associated with a reduction in hospital admissions, while a study published in the British Journal of General Practice last year found that having the same GP for six years or more significantly reduced mortality among older patients.

GP leaders have warned that if governments prioritise seven-day access and speed of access to routine GP services over continuity, patients will lose out and the profession will become less attractive to clinicians, who also value the relationship with their patient populations.

Winter crisis

As the NHS heads into a winter predicted to prove extremely challenging, the researchers warned that acute hospital services in England are under 'sustained pressure with increasing emergency attendances, resulting in longer waiting times in emergency departments and high bed occupancy rates', and said that improved continuity of care could ease the pressure on hospitals.

Lead author Dr Peter Tammes, senior research associate at the University of Bristol’s Centre for Academic Primary Care said: 'Our study shows that lack of continuity of care in this high-risk age group is associated with more frequent emergency admissions, which in turn suggests that better continuity of care might lead to a reduction in admissions. Discontinuity of care reduces the opportunity for building trust and mutual responsibility between doctors and patients, which might underlie the increased risk of emergency hospital admission.

'More research is needed to have a clearer understanding of how this association works and to understand patients’ values and experiences. It would also be helpful to evaluate new schemes to improve continuity of care, such as the introduction in 2014 of a named GP for elderly patients - especially as the merging of practices into ‘super-practices’ is expected to lead to an overall decrease in continuity of care.

'Despite the challenges, we hope that these findings support policy makers, commissioners, patients and GPs in their efforts to improve continuity of care, where the evidence supports it.'

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