1
|
Maarsingh OR. The Wall of Evidence for Continuity of Care: How Many More Bricks Do We Need? Ann Fam Med 2024; 22:184-186. [PMID: 38806275 PMCID: PMC11237230 DOI: 10.1370/afm.3116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 03/25/2024] [Indexed: 05/30/2024] Open
Affiliation(s)
- Otto R Maarsingh
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, The Netherlands
| |
Collapse
|
2
|
de Visser RO, Nwamba C, Brearley E, Shafiei V, Hart L. Remote consultations in primary care: Patient experiences and suggestions for improvement. J Health Psychol 2024:13591053241240383. [PMID: 38581309 DOI: 10.1177/13591053241240383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2024] Open
Abstract
The use of Remote Consultations (RCs) in primary care expanded rapidly during the Covid-19 pandemic: their ongoing use highlights a need to improve experiences of them. We interviewed 17 adults in the UK, including a sub-sample of five people with a First Language other than English (FLotE). Interpretative Phenomenological Analysis identified five major themes: (1) RCs are convenient, but they require appropriate technology and appropriate conditions of use; (2) even those with good general eHealth literacy and connectivity may struggle with systems that are not user-friendly; (3) greater reliance on verbal communication was experience as limiting empathy, and also made RCs more difficult for people with a FLotE; (4) RCs are considered inappropriate for complex conditions, or those with major psychological components; (5) continuity of care is important, but is often lacking. Overall, interviewees emphasised the need for more user-friendly processes, and greater attention to patients' preferences for consultation type.
Collapse
Affiliation(s)
| | | | | | | | - Lia Hart
- Brighton & Sussex Medical School, UK
| |
Collapse
|
3
|
Watson J, Green MA, Giebel C, Akpan A. Identifying longitudinal healthcare pathways and subsequent mortality for people living with dementia in England: an observational group-based trajectory analysis. BMC Geriatr 2024; 24:150. [PMID: 38350866 PMCID: PMC10865521 DOI: 10.1186/s12877-024-04744-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 01/24/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND The number of people living with dementia (PLWD) continues to increase, particularly those with severe symptomatology. Severe symptoms and greater ill-health result in more acute care need. Early healthcare interventions can prove beneficial. Healthcare use has not been analysed as a holistic set of interlinked events. This study explores different healthcare pathways among PLWD, social or spatial inequalities in healthcare pathways and subsequent mortality risk. METHODS Group-based trajectory models (GBTM) were applied to electronic healthcare records. We generated clusters of PLWD with similar five-year, post-diagnosis trajectories in rates of primary and secondary healthcare use. Potential social and spatial variations in healthcare use clusters were examined. Cox Proportional Hazards used to explore variation in subsequent mortality risk between healthcare use clusters. RESULTS Four healthcare use clusters were identified in both early- (n = 3732) and late-onset (n = 6224) dementia populations. Healthcare use variations were noted; consistent or diminishing healthcare use was associated with lower subsequent mortality risk. Increasing healthcare use was associated with increased mortality risk. Descriptive analyses indicated social and spatial variation in healthcare use cluster membership. CONCLUSION Healthcare pathways can help indicate changing need and variation in need, with differential patterns in initial healthcare use post-diagnosis, producing similar subsequent mortality risk. Care in dementia needs to be more accessible and appropriate, with care catered to specific and changing needs. Better continuity of care and greater awareness of dementia in primary can enhance prospects for PLWD. Research needs to further illuminate holistic care need for PLWD, including health and social care use, inequalities in care, health and outcomes.
Collapse
Affiliation(s)
- James Watson
- Department of Primary Care and Mental Health, The University of Liverpool, 1st Floor, Waterhouse Building B, Liverpool, L69 3GF, UK.
| | - Mark A Green
- School of Environmental Sciences, The University of Liverpool, Liverpool, UK
| | - Clarissa Giebel
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
- Applied Research Collaboration North West Coast, Liverpool, UK
| | - Asangaedem Akpan
- Department of Medicine for Older People and Stroke, Liverpool University Hospitals NHS FT, Liverpool, UK
- Healthy Ageing Group, University of Cumbria, Carlisle, UK
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Clinical Research Network, North West Coast, Liverpool, UK
| |
Collapse
|
4
|
Caughey GE, Rahja M, Collier L, Air T, Thapaliya K, Crotty M, Williams H, Harvey G, Sluggett JK, Gill TK, Kadkha J, Roder D, Kellie AR, Wesselingh S, Inacio MC. Primary health care service utilisation before and after entry into long-term care in Australia. Arch Gerontol Geriatr 2024; 117:105210. [PMID: 37812974 DOI: 10.1016/j.archger.2023.105210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/06/2023] [Accepted: 09/22/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVES To examine utilisation of primary health care services (subsidised by the Australian Government, Medicare Benefits Schedule, MBS) before and after entry into long-term care (LTC) in Australia. METHODS A retrospective cohort study of older people (aged ≥65 years) who entered LTC in Australia between 2012 and 2016 using the Historical Cohort of the Registry of Senior Australians. MBS-subsidised general attendances (general practitioner (GP), medical and nurse practitioners), health assessment and management plans, allied health, mental health services and selected specialist attendances accessed in 91-day periods 12 months before and after LTC entry were examined. Adjusted relative changes in utilisation 0-3 months before and after LTC entry were estimated using risk ratios (RR) calculated using Generalised Estimating Equation Poisson models. RESULTS 235,217 residents were included in the study with a median age of 84 years (interquartile range 79-89) and 61.1% female. In the first 3 months following LTC entry, GP / medical practitioner attendances increased from 86.6% to 95.6% (aRR 1.10 95%CI 1.10-1.11), GP / medical practitioner urgent after hours (from 12.3% to 21.1%; aRR 1.72, 95%CI 1.70-1.74) and after-hours attendances (from 18.5% to 33.8%; aRR 1.83, 95%CI 1.81-1.84) increased almost two-fold. Pain, palliative and geriatric specialist medicine attendances were low in the 3 months prior (<3%) and decreased further following LTC admission. CONCLUSION There is an opportunity to improve the utilisation of primary health care services following LTC entry to ensure that residents' increasingly complex care needs are adequately met.
Collapse
Affiliation(s)
- Gillian E Caughey
- The Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia; UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia; Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.
| | - Miia Rahja
- The Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia; Flinders Health and Medical Research Institute, Division of Rehabilitation, Aged and Palliative Care, Flinders Drive, Bedford Park, SA, Australia
| | - Luke Collier
- The Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Tracy Air
- The Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Kailash Thapaliya
- The Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia; UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Maria Crotty
- Flinders Health and Medical Research Institute, Division of Rehabilitation, Aged and Palliative Care, Flinders Drive, Bedford Park, SA, Australia; College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | | | - Gillian Harvey
- College of Nursing and Health Science, Flinders University, Adelaide, SA, Australia
| | - Janet K Sluggett
- The Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia; UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
| | - Tiffany K Gill
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia; Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Jyoti Kadkha
- The Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia; College of Nursing and Health Science, Flinders University, Adelaide, SA, Australia
| | - David Roder
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | | | - Steve Wesselingh
- The Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Maria C Inacio
- The Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia; UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| |
Collapse
|
5
|
Nordaunet OM, Gjevjon ER, Olsson C, Aagaard H, Borglin G. What about the fundamentals of nursing-its interventions and its continuity among older people in need of home- or facility-based care: a scoping review. BMC Nurs 2024; 23:59. [PMID: 38254154 PMCID: PMC10801980 DOI: 10.1186/s12912-023-01675-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024] Open
Abstract
AIM This scoping review investigated and descriptively summarised previous research about fundamental nursing, its focus (what care needs are described, how is it described and by whom is it described), continuity of care (is it described in relation to fundamental nursing) and possible nursing interventions or activities targeting older people's fundamentals of care needs in home- or facility-based care. METHODS This scoping review was carried out following the steps of Arksey and O'Malley's methodology and PRISMA-ScR reporting guidelines. Searches were conducted in PubMed via NIH, CINAHL via EBSCO and PsycInfo via ProQuest for the time period between January 2002 and May 2023. RESULTS Forty-two studies were included where the majority had been conducted in a facility-based care context. Nutrition-or rather nutritional care activities targeting eating and drinking-was the most frequently described fundamental care needs addressed. After this came personal care such as cleansing, dressing, oral care, skin, and foot care. Few studies addressed more than one fundamental care need at the time. The nursing staff described fundamental nursing as complex, comprehensive, and demanding. Older people and relatives described a gap between the fundamental nursing provided and their perceived need for support. Less attention was given to older peoples relational and psychosocial needs. Identified nursing interventions mainly targeted physical care needs. Our findings also implied that interventions focusing on fundamental nursing were described as feasible in practice with favourable or moderate results, while long-term effects were difficult to detect. No studies were identified focusing on fundamental nursing in relation to outcomes such as continuity of care. CONCLUSION Fundamental nursing was mainly described in relation to physical care needs, which were essentially conducted within facility-based care contexts. Interventions and activities primarily focused on one fundamental need at the time, mainly within the physical domain. No nursing interventions were identified focusing on relational and psychosocial needs where continuity of care can be viewed as a relevant outcome. Such limited focus are especially concerning as research has highlighted the importance of that older people with complex care needs can benefit from a holistic and person-centred approach i.e. fundamental nursing. TRIAL REGISTRATION Open Science Framework https://doi.org/10.17605/OSF.IO/XJ39E Protocol: http://dx.doi.org/10.1136/bmjopen-2022-069798.
Collapse
Affiliation(s)
- O M Nordaunet
- Department of Bachelor Education (Nursing), Lovisenberg Diaconal University College, Lovisenberggata 15B, NO-0456, Oslo, Norway.
- Institute of Health Sciences, Department of Nursing, Karlstad University, Universitetsgatan 2, 651 88, Karlstad, Sweden.
| | - E R Gjevjon
- Department of Bachelor Education (Nursing), Lovisenberg Diaconal University College, Lovisenberggata 15B, NO-0456, Oslo, Norway
- UiT The Arctic University of Norway, Havnegata 5, 9404, Harstad, Norway
| | - C Olsson
- Department of Bachelor Education (Nursing), Lovisenberg Diaconal University College, Lovisenberggata 15B, NO-0456, Oslo, Norway
- Institute of Health Sciences, Department of Nursing, Karlstad University, Universitetsgatan 2, 651 88, Karlstad, Sweden
| | - H Aagaard
- Department of Bachelor Education (Nursing), Lovisenberg Diaconal University College, Lovisenberggata 15B, NO-0456, Oslo, Norway
| | - G Borglin
- Department of Bachelor Education (Nursing), Lovisenberg Diaconal University College, Lovisenberggata 15B, NO-0456, Oslo, Norway
| |
Collapse
|
6
|
Inacio MC, Collier L, Air T, Thapaliya K, Crotty M, Williams H, Wesselingh SL, Kellie A, Roder D, Lewis A, Harvey G, Sluggett JK, Cations M, Gill TK, Khadka J, Caughey GE. Primary, allied health, geriatric, pain and palliative healthcare service utilisation by aged care residents, 2012-2017. Australas J Ageing 2023; 42:564-576. [PMID: 37070244 PMCID: PMC10947441 DOI: 10.1111/ajag.13199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 03/01/2023] [Accepted: 03/08/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVES To examine the incidence and trends in primary care, allied health, geriatric, pain and palliative care service use by permanent residential aged care (PRAC) residents and the older Australian population. METHODS Repeated cross-sectional analyses on PRAC residents (N = 318,484) and the older (≥65 years) Australian population (N ~ 3.5 million). Outcomes were Medicare Benefits Schedule (MBS) subsidised primary care, allied health, geriatric, pain and palliative services between 2012-13 and 2016-17. GEE Poisson models estimated incidence rates and incidence rate ratios (IRR). RESULTS In 2016-17, PRAC residents had a median of 13 (interquartile range [IQR] 5-19) regular general medical practitioner (GP) attendances, 3 (IQR 1-6) after-hours attendances and 5% saw a geriatrician. Highlights of utilisation changes from 2012-13 to 2016-17 include the following: GP attendances increased by 5%/year (IRR = 1.05, 95% confidence interval [CI] 1.05-1.05) for residents compared to 1%/year (IRR = 1.01, 95%CI 1.01-1.01) for the general population. GP after-hours attendances increased by 15%/year (IRR = 1.15, 95%CI 1.14-1.15) for residents and 9%/year (IRR = 1.08, 95%CI 1.07-1.20) for the general population. GP management plans increased by 12%/year (IRR = 1.12, 95%CI 1.11-1.12) for residents and 10%/year (IRR = 1.10, 95%CI 1.09-1.11) for the general population. Geriatrician consultations increased by 28%/year (IRR = 1.28, 95%CI 1.27-1.29) for residents compared to 14%/year (IRR = 1.14, 95%CI 1.14-1.15) in the general population. CONCLUSIONS The utilisation of most examined services increased in both cohorts over time. Preventive and management care, by primary care and allied health care providers, was low and likely influences the utilisation of other attendances. PRAC residents' access to pain, palliative and geriatric medicine services is low and may not address the residents' needs.
Collapse
Affiliation(s)
- Maria C. Inacio
- Registry of Senior Australians (ROSA)South Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
- UniSA Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Luke Collier
- Registry of Senior Australians (ROSA)South Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
| | - Tracy Air
- Registry of Senior Australians (ROSA)South Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
| | - Kailash Thapaliya
- Registry of Senior Australians (ROSA)South Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
| | - Maria Crotty
- College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
- Southern Adelaide Local Health NetworkSA HealthAdelaideSouth AustraliaAustralia
| | | | - Steve L. Wesselingh
- South Australian Health and Medical Research Institute (SAHMRI)AdelaideSouth AustraliaAustralia
| | - Andrew Kellie
- East Adelaide HealthcareNewtonSouth AustraliaAustralia
| | - David Roder
- UniSA Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Adrienne Lewis
- SA Health Dental ServiceAdelaideSouth AustraliaAustralia
| | - Gillian Harvey
- College of Nursing and Health SciencesFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Janet K. Sluggett
- Registry of Senior Australians (ROSA)South Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
- UniSA Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
- Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and SafetyMonash UniversityParkvilleVictoriaAustralia
| | - Monica Cations
- College of Education, Psychology and Social WorkFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Tiffany K. Gill
- Registry of Senior Australians (ROSA)South Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
- Adelaide Nursing SchoolUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Faculty of Health and Medical Sciences, Adelaide Medical SchoolThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Jyoti Khadka
- Registry of Senior Australians (ROSA)South Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
- College of Nursing and Health SciencesFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Gillian E. Caughey
- Registry of Senior Australians (ROSA)South Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
- UniSA Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| |
Collapse
|
7
|
Yang S, Zhou M, Liao J, Ding X, Hu N, Kuang L. Association between Primary Care Utilization and Emergency Room or Hospital Inpatient Services Utilization among the Middle-Aged and Elderly in a Self-Referral System: Evidence from the China Health and Retirement Longitudinal Study 2011-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912979. [PMID: 36232279 PMCID: PMC9564952 DOI: 10.3390/ijerph191912979] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/28/2022] [Accepted: 10/02/2022] [Indexed: 05/09/2023]
Abstract
With rapid economic growth and aging, hospital inpatient and emergency services utilization has grown rapidly, and has emphasized an urgent requirement to adjust and optimize the structure of health service utilization. Studies have shown that primary care is an effective way to reduce inpatient and emergency room (ER) service utilization. This study aims to examine whether middle-aged and elderly individuals who selected primary care outpatient services in the last month had less ER and hospital inpatient service utilization than those who selected hospitals outpatient services via the self-referral system. Data were obtained from four waves of the nationally representative China Health and Retirement Longitudinal Study (CHARLS). We pooled respondents who had outpatient visits and were aged 45 years and above. We used logistic regressions to explore the association between types of outpatient and ER visits or hospitalization, and then used zero-truncated negative binomial regression to examine the impact of outpatient visit types on the number of hospitalizations and the length of hospitalization days. A trend test was used to explore the trend of outpatient visit types and the ER or hospital inpatient services utilization with the increase in outpatient visits. Among the 7544 respondents in CHARLS, those with primary care outpatient visits were less likely to have ER visits (adjusted OR = 0.141, 95% CI: 0.101-0.194), hospitalization (adjusted OR = 0.623, 95% CI: 0.546-0.711), and had fewer hospitalization days (adjusted IRR = 0.886, 95% CI: 0.81-0.969). The trend test showed that an increase in the number of total outpatient visits was associated with a lower hospitalizations (p = 0.006), but a higher odds of ER visits (p = 0.023). Our findings suggest that policy makers need to adopt systematic policies that focus on restructuring and balancing the structure of resources and service utilization in the three-tier healthcare system.
Collapse
Affiliation(s)
- Siman Yang
- Department of Health Administration, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
| | - Mengping Zhou
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, 17177 Stockholm, Sweden
| | - Jingyi Liao
- Department of Health Administration, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
| | - Xinxin Ding
- Department of Health Administration, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
| | - Nan Hu
- Department of Biostatistics, FIU Robert Stempel College of Public Health and Social Work, Miami, FL 33199, USA
- Department of Family and Preventive Medicine and Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
- Correspondence: (N.H.); (L.K.)
| | - Li Kuang
- Department of Health Administration, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
- Correspondence: (N.H.); (L.K.)
| |
Collapse
|
8
|
Smithman MA, Haggerty J, Gaboury I, Breton M. Improved access to and continuity of primary care after attachment to a family physician: longitudinal cohort study on centralized waiting lists for unattached patients in Quebec, Canada. BMC PRIMARY CARE 2022; 23:238. [PMID: 36114464 PMCID: PMC9482231 DOI: 10.1186/s12875-022-01850-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 09/08/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Having a regular family physician is associated with many benefits. Formal attachment – an administrative patient-family physician agreement – is a popular feature in primary care, intended to improve access to and continuity of care with a family physician. However, little evidence exists about its effectiveness. In Quebec, Canada, where over 20% of the population is unattached, centralized waiting lists help attach patients. This provides a unique opportunity to observe the influence of attachment in previously unattached patients. The aim was to evaluate changes in access to and continuity of primary care associated with attachment to a family physician through Quebec’s centralized waiting lists for unattached patients.
Methods
We conducted an observational longitudinal population cohort study, using medical services billing data from public health insurance in the province of Québec, Canada. We included patients attached through centralized waiting lists for unattached patients between 2012 and 2014 (n = 410,140). Our study was informed by Aday and Andersen’s framework for the study of access to health services. We compared outcomes during four 12-month periods: two periods before and two periods after attachment, with T0–2 years as the reference period. Outcome measures were number of primary care visits and Bice-Boxerman Concentration of Care Index at the physician and practice level (for patients with ≥2 visits in a given period). We included age, sex, region remoteness, medical vulnerability, and Charlson Comorbidity Index as covariates in regression models fitted with generalized estimating equations.
Results
The number of primary care visits increased by 103% in the first post attachment year and 29% in the second year (p < 0.001). The odds of having all primary care visits concentrated with a single physician increased by 53% in the first year and 22% (p < 0.001) in the second year after attachment. At the practice level, the odds of perfect concentration of care increased by 19% (p < 0.001) and 15% (p < 0.001) respectively, in first and second year after attachment.
Conclusion
Our results show an increase in patients’ number of primary care visits and concentration of care at the family physician and practice level after attachment to a family physician. This suggests that attachment may help improve access to and continuity of primary care.
Collapse
|