Abstract

BackgroundContinuity of care is a well-recognized principle of the primary care discipline owing to its medical, interpersonal, and cost-saving benefits. Relationship continuity or the ongoing therapeutic relationship between a patient and their physician is a particularly desirable goal, but its role in preventing the accumulation of chronic conditions diagnoses in individuals is unknown. The objective of this study was to investigate the effect of continuity of care with physicians on the rate of incident multimorbidity diagnoses in patients with existing conditions.MethodsThis was a population-based, retrospective cohort study from 2001 to 2015 that focused on patients aged 18 to 105 years with at least one chronic condition (n = 166,665). Our primary exposure was relationship continuity of care with general practitioners and specialists measured using the Bice-Boxerman Continuity of Care Index (COCI). COCI was specified as a time-dependent exposure prior to the observation period. Our outcomes of interest were the time to diagnosis of a second, third, and fourth chronic condition estimated using cause-specific hazard regressions accounting for death as a competing risk.FindingsWe observed that patients with a single chronic condition and high continuity of care (>0.50) were diagnosed with a second chronic condition or multimorbidity at an 8% lower rate compared to individuals with low continuity (cause-specific hazard ratio (HR) 0.92 (95% Confidence Interval 0.90–0.93; p<0.0001) after adjusting for age, sex, income, place of residence, primary care enrolment, and the annual number of physician visits. Continuity remained protective as the degree of multimorbidity increased. Among patients with two conditions, the risk of diagnosis of a third chronic condition was also 8% lower for individuals with high continuity (HR 0.92; CI 0.90–0.94; p<0.0001). Patients with three conditions and high continuity had a 9% lower risk of diagnosis with a fourth condition (HR 0.91; CI 0.89–0.93; p<0.0001).ConclusionsContinuity of care is a potentially modifiable health system factor that reduces the rate at which diagnoses of chronic conditions are made over time in patients with multimorbidity. Additional research is needed to explain the underlying mechanisms through which continuity is related to a protective effect and the clinical sequalae.

Highlights

  • A notable challenge for healthcare systems arising from the aging of populations and improvements in life expectancy is the increase in the number of patients with chronic conditions

  • Continuity of care is a potentially modifiable health system factor that reduces the rate at which diagnoses of chronic conditions are made over time in patients with multimorbidity

  • The proportion of patients that are living with multimorbidity or more than one condition at the same time in particular has risen considerably. This is an issue in Ontario, Canada where estimates indicate that nearly a quarter of the population is multimorbid, with 83% of the elderly having been diagnosed with multiple chronic conditions [1]

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Summary

Introduction

A notable challenge for healthcare systems arising from the aging of populations and improvements in life expectancy is the increase in the number of patients with chronic conditions. The proportion of patients that are living with multimorbidity or more than one condition at the same time in particular has risen considerably. This is an issue in Ontario, Canada where estimates indicate that nearly a quarter of the population is multimorbid, with 83% of the elderly having been diagnosed with multiple chronic conditions [1]. Relationship continuity or the ongoing therapeutic relationship between a patient and their physician is a desirable goal, but its role in preventing the accumulation of chronic conditions diagnoses in individuals is unknown. The objective of this study was to investigate the effect of continuity of care with physicians on the rate of incident multimorbidity diagnoses in patients with existing conditions

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