Background and Goal: Relational continuity, the ongoing relationship between a patient and a family physician, is linked to better patient care, fewer unnecessary procedures, hospitalizations, emergency department visits, and lower costs, along with higher patient satisfaction. With the rise of part-time practices, patients often see multiple family physicians within the same clinic. This study aimed to explore how continuity in a primary care clinic—separate from individual physician continuity—affects patient health outcomes in Alberta, Canada.
Study Approach: The study analyzed linked health administrative data from Alberta from 2015 to 2018. It examined the relationship between both physician and clinic continuity and the rates of emergency department visits and hospitalizations, considering various levels of patient complexity. Continuity was measured by the percentage of visits a patient made to their regular family physician compared to all primary care visits. Patients were included if they had at least three visits in a three-year period, with continuity categorized into low (0-40%), moderate (41-80%), and high (81-100%) groups. Patient complexity was assessed using the clinical risk grouper (CRG) methodology, which assigns one of nine complexity levels based on health history.
Main Results: 44% of patients were male and 56% female. Researchers found that known clinician continuity is associated with reduced emergency room visits and hospitalizations, especially in complex patients. Most patients had moderate to high continuity with their family physician. Patients who frequently visited the same clinic group also had fewer hospital and emergency department visits, indicating that larger group practices might facilitate better care continuity. Additionally, continuity within clinics was associated with improved outcomes, but the effect of clinic continuity was less pronounced than the effect of known clinician continuity. Group continuity was more important for complex patients than for less complex patients.
Why It Matters: Consistently seeing the same family physician, or at least staying within the same clinic group, is associated with improved health outcomes. These findings highlight the importance of clinic continuity in community primary care and suggest areas for further research, especially regarding why patients receiving low levels of group care face slight disadvantages. This study provides valuable insights for future primary care design and investment. Rather than investing in urgent care, the authors suggest that investing in collaborative primary care clinics may result in better outcomes for patients.
The Impact of Primary Care Clinic and Family Physician Continuity on Patient Health Outcomes: A Retrospective Analysis From Alberta, Canada
Terrence McDonald, MD, MSc, et al
Department of Family Medicine, Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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