Does continuity of care matter in a universally insured population?
OBJECTIVE
To examine the relation between continuity of care and preventive health care and emergency department (ED) use in a universal health care system.


METHODS
Administrative data that capture health care use of the entire population of a midwestern Canadian city.


METHODS
A population-based, retrospective study of all individuals who had a least one physician contact in 1998 or 1999 (total N=536,893).


METHODS
Logistic regressions were conducted to examine the relation between continuity of care, defined in terms of the proportion of total visits to family physicians (FPs) made to the same FP, and cervical cancer screening, breast cancer screening, influenza vaccination, pneumococcal vaccination, and ED visits, controlling for demographic variables, socioeconomic status (defined in terms of relative affluence of neighborhood of residence), and health status.


RESULTS
Continuity of care was related to better preventive health care and reduced ED use. A consistent socioeconomic gradient also emerged. For instance, the odds of having a mammogram was double for individuals living in the wealthiest neighborhoods, relative to those in the poorest neighborhoods (adjusted odds ratio=2.31, 99 percent CI 2.13-2.50).


CONCLUSIONS
Having a long-term relationship with a single physician makes a difference even in a universal health care system. Moreover, socioeconomic disparities remain, suggesting the need to target specifically individuals from lower socioeconomic strata for preventive health care.
Menec
Verena H
VH
Center on Aging, 338 Isbister Building, University of Manitoba, Winnipeg, Manitoba, R3T 2N2, Canada.
Sirski
Monica
M
Attawar
Dhiwya
D
D000328:Adult; D000368:Aged; D016001:Confidence Intervals; D003266:Continuity of Patient Care / Q000191:economics; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005194:Family Practice / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000191:economics; D006302:Health Services Research; D006801:Humans; D016015:Logistic Models; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D008875:Middle Aged; D009313:National Health Programs / Q000706:statistics & numerical data*; D016017:Odds Ratio; D011204:Poverty Areas; D011314:Preventive Health Services / Q000191:economics / Q000706:statistics & numerical data*; D011369:Professional-Patient Relations; D012111:Residence Characteristics; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014504:Urban Health