Discontinuity of care linked to emergency admission risk

A LACK of continuity in the primary care of patients over age 65 has been linked to a higher risk of emergency hospital admission, according to a new study.

Researchers from Bristol and Oxford analysed records from 10,000 patients aged over 65 years within 297 English general practices and 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.

The study comes as acute hospital services in England are struggling with increased emergency attendances, resulting in longer waiting times in A&E departments and high bed occupancy rates. These are both associated with poorer clinical outcomes as well as greater demands on staff. Previous evidence suggests that some patients admitted as emergencies could be managed at home.

The researchers suggest that initiatives to enhance continuity of care could potentially reduce hospital admissions.

Dr Peter Tammes, Senior Research Associate at the University of Bristol's Centre for Academic Primary Care and lead author said: "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."

Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, commented: "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. This research provides clear evidence to reinforce this.

"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."

The study used 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 increases 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, but the hazard ratio for patients experiencing least continuity was 2.27 compared with those having 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.

The research was funded by the NIHR School for Primary Care Research and published in the Annals of Family Medicine.