Primary care continuity and potentially avoidable hospitalization in persons with dementia
Previous presentations: A subset of the preliminary results was presented at national and international conferences, as well as during local stakeholders' meetings: the Annual event of the French Geriatrics and Gerontology Society (2019), the 10th Canadian Conference on Dementia (2019), the North American Primary Care Research Group Annual Meeting (NAPCRG 2019), a stakeholder consultation of the Team ROSA (Research on Organization of Healthcare Services for Alzheimers) (June 2019); to the Quebec Ministry of Health (December 2018, June 2019); to the Quebec National Public Health Institute (September 2019); at a webinar held by the Quebec Alzheimer Society (2020). The full and final results have not been previously presented at a meeting or submitted elsewhere.
See related editorial by Amjad et al. in this issue.
Funding information: Canadian Institutes of Health Research; Fonds de Recherche du Québec - Santé; Vanier Canada Graduate Scholarship
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.
CONFLICT OF INTEREST
All the authors declare no conflict of interest.
