Primary care continuity and potentially avoidable hospitalization in persons with dementia
- 26 February 2021
- journal article
- research article
- Published by Wiley in Journal of the American Geriatrics Society
- Vol. 69 (5), 1208-1220
- https://doi.org/10.1111/jgs.17049
Abstract
Background/Objective To measure the association between high primary care continuity and potentially avoidable hospitalization in community‐dwelling persons with dementia. Our hypothesis was that high primary care continuity is associated with fewer potentially avoidable hospitalizations. Design Population‐based retrospective cohort (2012–2016), with inverse probability of treatment weighting using the propensity score. Setting Quebec (Canada) health administrative database, recording most primary, secondary and tertiary care services provided via the public universal health insurance system. Participants Population‐based sample of 22,060 community‐dwelling 65 + persons with dementia on March 31st, 2015, with at least two primary care visits in the preceding year (mean age 81 years, 60% female). Participants were followed for 1 year, or until death or long‐term care admission. Exposure High primary care continuity on March 31st, 2015, i.e., having had every primary care visit with the same primary care physician, during the preceding year. Main outcome measures Primary: Potentially avoidable hospitalization in the follow‐up period as defined by ambulatory care sensitive conditions (ACSC) hospitalization (general and older population definitions), 30‐day hospital readmission; Secondary: Hospitalization and emergency department visit. Results Among the 22,060 persons, compared with the persons with low primary care continuity, the 14,515 (65.8%) persons with high primary care continuity had a lower risk of ACSC hospitalization (general population definition) (relative risk reduction 0.82, 95% CI 0.72–0.94), ACSC hospitalization (older population definition) (0.87, 0.79–0.95), 30‐day hospital readmission (0.81, 0.72–0.92), hospitalization (0.90, 0.86–0.94), and emergency department visit (0.92, 0.90–0.95). The number needed to treat to prevent one event were, respectively, 118 (69–356), 87 (52–252), 97 (60–247), 23 (17–34), and 29 (21–47). Conclusion Increasing continuity with a primary care physician might be an avenue to reduce potentially avoidable hospitalizations in community‐dwelling persons with dementia on a population‐wide level.Keywords
Funding Information
- Canadian Institutes of Health Research
- Fonds de Recherche du Québec - Santé
This publication has 39 references indexed in Scilit:
- Which features of primary care affect unscheduled secondary care use? A systematic reviewBMJ Open, 2014
- Hospital And ED Use Among Medicare Beneficiaries With Dementia Varies By Setting And Proximity To DeathHealth Affairs, 2014
- Causes of Hospital Admission for People With Dementia: A Systematic Review and Meta-AnalysisJournal of the American Medical Directors Association, 2013
- Causes of crises and appropriate interventions: The views of people with dementia, carers and healthcare professionalsAging & Mental Health, 2013
- An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational StudiesMultivariate Behavioral Research, 2011
- A Tutorial and Case Study in Propensity Score Analysis: An Application to Estimating the Effect of In-Hospital Smoking Cessation Counseling on MortalityMultivariate Behavioral Research, 2011
- The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studiesJournal of Clinical Epidemiology, 2008
- Diagnosis and treatment of dementia: Introduction. Introducing a series based on the Third Canadian Consensus Conference on the Diagnosis and Treatment of DementiaCMAJ : Canadian Medical Association Journal, 2007
- The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational StudiesAnnals of Internal Medicine, 2007
- Continuity of care: a multidisciplinary reviewBMJ, 2003