A time-duration measure of continuity of care to optimise utilisation of primary health care: a threshold effects approach among people with diabetes

Ninh Thi Ha,Suzanne Robinson,Mark Harris,David Preen,Rachael Moorin

doi:10.1186/s12913-019-4099-9

Ninh Thi Ha, Suzanne Robinson + Show 3 more

Open Access

https://doi.org/10.1186/s12913-019-4099-9

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Abstract

BackgroundLiterature highlighted the importance of timely access and ongoing care provided at primary care settings in reducing hospitalisation and health care resource uses. However, the effect of timely access to primary care has not been fully captured in most of the current continuity of care indices. This study aimed to develop a time-duration measure of continuity of primary care (“cover index”) capturing the proportion of time an individual is under the potentially protective effect of primary health care contacts.MethodsAn observational study was conducted on 36,667 individuals aged 45 years or older with diabetes mellitus extracted from Western Australian linked administrative data. Threshold effect models were used to determine the maximum time interval between general practitioner (GP) visits that afforded a protective effect against avoidable hospitalisation across complication cohorts. The optimal maximum time interval was used to compute a cover index for each individual. The cover was evaluated using descriptive statistics stratified by population socio-demographic characteristics.ResultsThe optimal maximum time between GP visits was 9–13 months for people with diabetes with no complication, 5–11 months for people with diabetes with 1–2 complications, and 4–9 months for people with diabetes with 3+ complications. The cover index was lowest among those aged 75+ years, males, Indigenous people, socio-economically disadvantaged and those in very remote areas.ConclusionsThis study developed a new measure of continuity of primary care that adds a time parameter to capturing longitudinal continuity. Cover has the potential to better capture underuse of primary care and will significantly contribute to the sparsely available methods for analysis of linked administrative data in evaluating continuity of care for people with chronic conditions.

Highlights

Literature highlighted the importance of timely access and ongoing care provided at primary care settings in reducing hospitalisation and health care resource uses
Since individuals could change complication cohorts throughout the study the total number of individuals shown in Table 1 reflects the number of individuals who were classified in that particular complication cohort at any time and is larger than the total number of individuals in the study
Our study aimed to develop and operationalise the cover index, a novel measurement of continuity of primary care that represents an improvement in existing measurements of regularity of primary care through accounting for a time-limited protective effect achieved from interaction with a general practitioner (GP)

Summary

Introduction

Literature highlighted the importance of timely access and ongoing care provided at primary care settings in reducing hospitalisation and health care resource uses. Over recent years the focus in many countries has been the enhancement of primary health care to reduce potentially preventable hospitalisations (PPH) which are often costly and undesirable for patients [52] The rationale behind this is that timely utilisation and effective treatment in primary health care (PHC) settings for people with chronic conditions could afford a protective effect in preventing complications and adverse health events [10, 47]. For common chronic conditions such as diabetes, heart failure and asthma, a shift in focus from acute to primary care has the potential to delay or even prevent the onset of complications and reduce PPH This theory surrounding ‘ambulatory care sensitive condition’ has been the driver of many policies aimed at increasing long-term ongoing, rather than sporadic or episodic, contact with a General Practitioner (GP). The role of GPs has been emphasised that GPs are the only physicians appropriate for taking the leading roles in the primary health care team and coordinating with other health care professionals into providing the best patient centred care including diagnosis, treatment and management [5]

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