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Continuity of GP care could prevent emergency hospitalisation

Seeing different GP every time doubles risk of hospitalisation

Adrian O'Dowd

Thursday, 16 November 2017

Older patients who do not see the same GP over a period of time appear to be at higher risk of emergency hospital admission than people who see the same or a small number of GPs, suggests new research.

A new study* published in the Annals of Family Medicine found that the risk of emergency hospital admission was more than twice as high for patients with the least continuity of care compared with those with high continuity of care.

Acute hospital services in England are under pressure with increasing emergency attendances, resulting in longer waiting times in emergency departments and high bed occupancy rates.

Previous evidence suggests that some patients admitted as emergencies could be managed at home and initiatives to enhance continuity of care could potentially reduce hospital admissions.

Researchers at the Universities of Bristol and Oxford analysed data from 10,000 electronic records of patients aged 65 years and older, from 297 general practices in England, between April 2010 and March 2014.

These data were linked to hospital records to measure the association between continuity of care and risk of emergency hospital admission.

The researchers focused on older patients because they are seen more frequently in general practice than younger adult patients and are most at risk of emergency hospital admission.

The study used two research approaches – a prospective cohort approach, to assess the general impact of continuity of care on emergency admission, and a nested case-control approach, to test if seeing a different GP from usual increased the risk of emergency admission during the following 30 days.

The prospective approach found a graded non-significant inverse relationship between continuity of care and risk of emergency hospitalisation, though patients experiencing least continuity had a risk more than twice as high than those who had complete continuity.

The retrospective approach found a graded inverse relationship between continuity of care and emergency hospitalisation, with an odds ratio of 2.32 for those experiencing least continuity compared with those with most continuity.

Dr Peter Tammes, senior research associate at the University of Bristol's Centre for Academic Primary Care and lead author 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. 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.”

Professor Helen Stokes-Lampard, RCGP chair, said: “We have known for decades that our patients value continuity of care – and GPs value continuity of care with our patients too, particularly our older patients and those living with long-term conditions.

“General practice is striving to provide this to the best of our ability, but we are currently facing intense resource and workforce pressures, and our patients are already waiting longer and longer for appointments, so sometimes it is simply not possible.”

* Tammes P, Purdy S, Salisbury C, et al. Continuity of primary care and emergency hospital admissions among older patients in England. Ann Fam Med November/December 2017 15:515-522; DOI:10.1370/afm.2136

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