Better primary care continuity improves patient outcomes after hospital discharge

Introduction — We examined the effect of the quality of primary care continuity on readmission to a general admitting clinical teaching unit (GACTU), any hospital readmission, and emergency department (ED) visits within 1 year of discharge from a GACTU in Ontario.

Methods — Using a retrospective cohort design combining administrative and electronic medical record data, we categorized adult patients based on a time-varying covariate into four groups of quality of primary care continuity based on primary care use preceding each patient outcome in the follow-up period: (1) rostered and saw their rostered primary care physician (PCP), (2) rostered but did not see their rostered PCP, (3) non-rostered but saw the same PCP 2+ times, and (4) non-rostered and did not see the same PCP 2+ times.

Results — After adjusting for covariates, group 2 patients had greater risk of each outcome than group 1 patients (reference group): GACTU readmission (hazard ratio [HR]: 1.24; 95% CI 1.002 to 1.54; p = .048), hospital readmission (HR: 1.29; 95% CI 1.10 to 1.53; p = .002), and ED visit (HR: 1.22; 95% CI 1.06 to 1.40; p = .005).

Discussion — This exploratory study suggests higher quality of primary care continuity was associated with fewer re-encounters with acute care.