Study: Continuity in primary care reduces admissions

Doctor with patient
Patients that visited the same primary care provider regularly were less likely to be readmitted to the hospital, according to a new study.

Greater continuity in primary care could reduce hospital admissions and lower costs, according to a new British study.

The research, which was published in The BMJ, divided more than 230,000 patients between the ages of 62 and 82 into three groups based on their continuity of care. All of the participants met with a primary care provider at least twice between April 2011 and March 2013, according to the study, but those who met with the same doctor most frequently had about 12% fewer admissions for ambulatory care-sensitive conditions compared to those with lower continuity of care.

The middle group, which met with providers less often but still more than the bottom tier and included the most patients (about 42%), experienced nearly 9% fewer admissions, according to the study.

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The researchers found that patients who spent the most time interacting with general practitioners in general—but scheduled visits with a number of different doctors—had the highest levels of admissions. This emphasized the need for continuity of care, according to the researchers. It's especially important for an aging population, as their care needs are often more complex and require more coordination.

In an accompanying editorial, Peter Tammes, Ph.D., a senior research associate at the University of Bristol, and Chris Salisbury, M.D., professor of primary healthcare at that university, note that one factor that can lead to these admission reductions is that patients who make regular visits to their PCP are far less likely to make trips to the emergency room for routine care.

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“We hypothesize that seeing the same doctor ... builds trust and a sense of mutual responsibility between patients and [general practitioners],” they wrote. “A primary care system that is increasingly fragmented, in which neither patients nor doctors feel strongly connected to their local general practice, provides the setting for patients to choose to attend an emergency department instead.”

Other studies have suggested that increasing patients' access to primary care can reduce their ER use. Another U.K. study, for instance, found that PCPs that offer weekend and evening hours saw a 26% relative reduction in patient-initiated emergency visits for minor problems when compared with patients at practices that provide care during regular hours.

Patients with unmet social needs are often the most likely to be emergency care “super users,” and those social issues may limit their ability to get needed primary care.