Continuity of Family Physician Care - Is it more Important for Older People and the Chronically-Ill?

Abstract

To investigate the association of continuity of family physician (FP) care with health care services by age-group and chronic-disease status. Canadian Community Health Survey (2000/01) data were linked to administrative physician and hospital data via health insurance number. The Continuity of Care Index was used to classify survey participants as having either low or high continuity of FP care. Participants were also classified by age (< or ≥ 50 years) and by chronic disease status (chronically-ill or healthy). Proportions of participants having specialist visits and hospitalizations were compared between groups. Among the chronically-ill, a lower proportion of those in the high continuity group had specialist visits compared to those in the low continuity group (p<0.05). No differences in specialist visits were found in the healthy group (p>0.05). When analyzed by age, the proportion of participants having specialist visits was lower in the high continuity group for both age groups (p<0.05). No between-group differences were observed in proportion hospitalized. Logistic regression revealed that chronically-ill participants with low continuity were more likely to have specialist visits (odds ratio (OR)= 1.63, 95% confidence interval (CI): 1.25–2.13). No such association was found for the healthy group (OR= 1.24, 95% CI: 0.95–1.69). When analyzed by age, logistic regression showed that participants with low continuity were more likely to have specialists visits in both those aged ≥50 (OR= 1.53, 95% CI: 1.06–1.21) and those <50 (OR= 1.41, 95% CI: 1.11–1.79). Findings suggest that: 1) high continuity of family physician care is associated with decreased specialist utilization in the chronically-ill but not in the healthy; 2) high continuity of family physician care is associated with decreased specialist utilization in both younger and older age groups; and 3) continuity is not associated with hospitalization.