Influence of organization and demographic characteristics of primary care practices on continuity of care: analysis of a retrospective cohort from 287 primary care practices covering about 6 million people in Catalonia

Ermengol Coma,Manuel Medina,Mència Benítez,Mireia Fàbregas,Francesc Fina,Paula Peremiquel-Trillas,Núria Mora,Albert Mercadé,Leonardo Méndez

doi:10.1186/s12875-021-01414-y

Abstract

BackgroundThere is evidence that an ongoing patient-physician relationship is associated with improved health outcomes and more efficient health systems. The main objective of this study is to describe the continuity of care in primary healthcare in Catalonia (Spain) and to analyze whether the organization of primary care practices (PCP) or their patients’ sociodemographic characteristics play a role in its continuity of care.MethodsFour indices were used to measure continuity of care: Usual Provider Index (UPC), Modified Modified Continuity Index (MMCI), Continuity of Care Index (COC), and Sequential Continuity Index (SECON). The study was conducted on 287 PCP of the Catalan Institute of Health (Institut Català de la Salut—ICS). Each continuity of care index was calculated at the patient level (3.2 million patients and 35.5 million visits) and then aggregated at the PCP level. We adjusted linear regression models for each continuity index studied, considering the result of the index as an independent variable and demographic and organizational characteristics of the PCP as explanatory variables. Pearson correlation tests were used to compare the four continuity of care indices.ResultsIndices’ results were: UPC: 70,5%; MMCI: 73%; COC: 53,7%; SECON: 60,5%. The continuity of care indices had the highest bivariate correlation with the percentage of appointments booked with an assigned health provider (VISUBA variable: the lower the value, the higher the visits without an assigned health provider, and thus an organization favoring immediate consultation). Its R2 ranged between 56 and 63%, depending on the index. The multivariate model which explained better the variability of continuity of care indices (from 49 to 56%) included the variables VISUBA and rurality with a direct relationship; while the variables primary care physician leave days and training practices showed an inverse relationship.ConclusionStudy results suggest that an organization of primary care favoring immediate consultation is related to a lower continuity of patient care.

Highlights

There is evidence that an ongoing patient-physician relationship is associated with improved health outcomes and more efficient health systems
Recent articles have pointed out some threats to the continuity of care related to organizational issues like precarious working conditions and understaffing, segmentation of primary healthcare activities and the prioritization of access over continuity, which creates an increase of immediate attention [12, 13]
The four continuity indices were measured for every primary care practices (PCP) (Table 2)

Summary

Introduction

There is evidence that an ongoing patient-physician relationship is associated with improved health outcomes and more efficient health systems. Recent articles have pointed out some threats to the continuity of care related to organizational issues like precarious working conditions and understaffing, segmentation of primary healthcare activities and the prioritization of access over continuity, which creates an increase of immediate attention [12, 13]. This last threat is usually a consequence of the increase in waiting time for anything other than an emergency [13]. Despite the increase in organizational models in primary care practices (PCP) that promote immediate consultation to improve access (regardless of the real urgency of the medical problem) [10], there is no literature providing quantitative evidence of its effect on continuity of care

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Conclusion