Primary care utilization and attachment among burn survivors: a population-based matched cohort study

Background — Many burn survivors experience poor long-term outcomes, including reduced quality of life and greater mortality than the general population, yet post-discharge interventions to improve these outcomes remain underexplored. Given that access to primary care is associated with improved long-term health, we sought to characterize post-discharge primary care utilization among burn survivors to guide healthcare resource planning and support the long-term health of this population.

Methods — This retrospective, population-based, matched cohort study identified adults who survived to discharge after major burn injury between 2010 and 2022. Burn survivors were matched with up to five individuals without burn injuries on age, sex, and a propensity score based on individuals’ medical and psychiatric comorbidity, rurality, immigration status, and socioeconomic characteristics. The primary outcome was rate of primary care provider (PCP) visits within two years post-discharge, and the secondary outcome was post-discharge PCP attachment. PCP visit rates were analyzed using a Generalized Estimating Equation (GEE) negative binomial regression, and PCP attachment was assessed using a GEE log-binomial model.

Results — We identified 1925 burn survivors (median [IQR] age 47 [27] years, 73% male) and matched them to 9484 controls. The mean PCP visit rate was higher in burn survivors (4.4 vs. 3.5 visits per person-year; RR = 1.29, 95% CI: 1.20–1.39, p < 0.001). Burn survivors had more visits for mental health, while matched controls had more visits for routine care. PCP attachment was similar between burn survivors and controls (90% vs. 89%; RR = 1.01, 95% CI: 0.99–1.03, p = 0.17).

Conclusion — Burn survivors had greater primary care utilization than matched controls without burn injuries in the two years after burn injury. Given both the complexity and rarity of burn injuries, post-discharge care models are needed to support PCPs with the management of long-term burn-related care.