{"id":21910,"date":"2025-06-01T10:27:43","date_gmt":"2025-06-01T14:27:43","guid":{"rendered":"https:\/\/www.ices.on.ca\/?post_type=journal_article&#038;p=21910"},"modified":"2025-06-06T10:35:34","modified_gmt":"2025-06-06T14:35:34","slug":"association-of-primary-care-continuity-with-home-dialysis-transplantation-and-utilization-of-medical-services-for-patients-starting-hemodialysis","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/association-of-primary-care-continuity-with-home-dialysis-transplantation-and-utilization-of-medical-services-for-patients-starting-hemodialysis\/","title":{"rendered":"Association of primary care continuity with home dialysis, transplantation, and utilization of medical services for patients starting hemodialysis"},"content":{"rendered":"<p><strong>Rationale and objective<\/strong> \u2014Primary care may help patients starting dialysis with emotional support and access to health care services. It is unknown whether consistently visiting the same primary care physician (PCP) can strengthen patient confidence to select home dialysis, help facilitate medical appointments for transplantation, or increase care access.<\/p>\n<p><strong>Study design<\/strong> \u2014 A population-based retrospective cohort study.<\/p>\n<p><strong>Setting and participants<\/strong> \u2014 Patients initiating maintenance hemodialysis from 2007 to 2017 in Ontario, Canada.<\/p>\n<p><strong>Exposure<\/strong> \u2014 High PCP continuity using the usual provider of care index (an established measure of PCP continuity), defined as&gt;75% of PCP visits with the same PCP in the 2 years before dialysis initiation.<br \/>\nOutcomes \u2014 Primary outcomes were time to home dialysis (peritoneal or hemodialysis) and transplantation. Secondary outcomes included specialist visits, cancer screening, influenza vaccination, and measures of diabetes care.<\/p>\n<p><strong>Analytical approach<\/strong> \u2014 Propensity scores to match patients with high and low PCP continuity.<br \/>\nResults \u2014 We identified 9,530 matched pairs. High PCP continuity was not associated with increased home dialysis (14.0 events per 100 person-years vs 14.0 events per 100 person-years; subdistribution hazard ratio 1.00; 95% CI, 0.97-1.04) or transplantation (4.3 events per 100 person-years vs 4.5 events per 100 person-years; subdistribution hazard ratio 0.97; 95% CI, 0.90-1.04). High PCP continuity was associated with greater colon cancer screening (hazard ratio 1.07; 95% CI, 1.01-1.14), influenza vaccination (hazard ratio 1.33; 95% CI, 1.27-1.39), and comprehensive diabetes care (hazard ratio 1.23; 95% CI, 1.14-1.33).<\/p>\n<p><strong>Limitations<\/strong> \u2014 Residual confounding is possible.<\/p>\n<p><strong>Conclusions<\/strong> \u2014 High PCP continuity before dialysis initiation was not associated with increased utilization of home dialysis or transplantation but was associated with greater colon cancer screening, influenza vaccination, and comprehensive diabetes care. Additional work is needed to clarify how primary care may best benefit this patient population.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Rationale and objective \u2014Primary care may help patients starting dialysis with emotional support and access to health care services. It is unknown whether consistently visiting the same primary care physician (PCP) can strengthen patient confidence to select home dialysis, help facilitate medical appointments for transplantation, or increase care access. Study design \u2014 A population-based retrospective [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[62,49,28],"migration-helper-qa-sample-set":[],"class_list":["post-21910","journal_article","type-journal_article","status-publish","hentry","topic-health-services-research","topic-kidney-disease","topic-primary-care"],"acf":{"citation":"Wyman CS, Djerboua M, Clemens KK, Harel Z, Sood MM, Silver SA. <em>Kidney Med<\/em>. 2025; 7(6):101015. Epub 2025 Apr 29.","source_url":"https:\/\/doi.org\/10.1016\/j.xkme.2025.101015","ices_scientist":[1206,1256,1357],"site":[6736],"research_program":[6743],"news_release":"","journal_article":"","atlas":"","research_report":"","infographic":"","video":"","downloads":null,"links":null,"sitecore_item_id":"","sitecore_item_name":"","sitecore_field_values":"","previous_url":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Association of primary care continuity with home dialysis, transplantation, and utilization of medical services for patients starting hemodialysis<\/title>\n<meta name=\"description\" content=\"Rationale and objective \u2014Primary care may help patients starting dialysis with emotional support and access to health care services. 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