Continuity of care in primary care and association with survival in older people: a 17-year prospective cohort study.
BACKGROUND
Although continuity of care is a widely accepted core principle of primary care, the evidence about its benefits is still weak.


OBJECTIVE
To investigate whether continuity of care in general practice is associated with better survival in older people.


METHODS
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.


METHODS
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 <1 were divided into tertiles, with a fourth category for participants with maximum COC. Cox regression analysis was used to investigate the association between COC and survival time.


RESULTS
Seven hundred and forty-two participants (43.3%) reported a maximum COC. Among the 759 participants surviving 17 years, 251 (33.1%) still had the same GP. The lowest COC category (index >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.


CONCLUSIONS
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.
Otto R
OR
Maarsingh
Ykeda
Y
Henry
Peter M
PM
van de Ven
Dorly Jh
DJ
Deeg
D000368:Aged; D002908:Chronic Disease / Q000401:mortality; D003266:Continuity of Patient Care / Q000592:standards*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000592:standards; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016019:Survival Analysis; D013997:Time Factors
aged; cohort studies; continuity of patient care; mortality; primary health care