Intended for healthcare professionals

CCBYNC Open access

Association between continuity of care in general practice and hospital admissions for ambulatory care sensitive conditions: cross sectional study of routinely collected, person level data

BMJ 2017; 356 doi: (Published 01 February 2017) Cite this as: BMJ 2017;356:j84
  1. Isaac Barker, data analyst1,
  2. Adam Steventon, director of data analytics1,
  3. Sarah R Deeny, assistant director of data analytics1
  1. 1Data Analytics, The Health Foundation, London WC2E 9RA, UK
  1. Correspondence to: I Barker isaac.barker{at}
  • Accepted 21 December 2016


Objective To assess whether continuity of care with a general practitioner is associated with hospital admissions for ambulatory care sensitive conditions for older patients.

Design Cross sectional study.

Setting Linked primary and secondary care records from 200 general practices participating in the Clinical Practice Research Datalink in England.

Participants 230 472 patients aged between 62 and 82 years and who experienced at least two contacts with a general practitioner between April 2011 and March 2013.

Main outcome measure Number of hospital admissions for ambulatory care sensitive conditions (those considered manageable in primary care) per patient between April 2011 and March 2013.

Results We assessed continuity of care using the usual provider of care index, which we defined as the proportion of contacts occurring between April 2011 and March 2013 that were with the most frequently seen general practitioner. On average, the usual provider of care index score was 0.61. Continuity of care was lower among practices with more doctors (average score 0.59 in large practices versus 0.70 in small practices). Higher continuity of care was associated with fewer admissions for ambulatory care sensitive conditions. When modelled, controlling for demographic and clinical patient characteristics, an increase in the usual provider of care index of 0.2 for all patients would reduce these admissions by 6.22% (95% confidence interval 4.87% to 7.55%). There was greater evidence for an association among patients who were heavy users of primary care. Heavy users also experienced more admissions for ambulatory care sensitive conditions than other patients (0.36 admissions per patient for those with ≥18 contacts with a general practitioner, compared with 0.04 admissions per patient for those with 2-4 contacts).

Conclusions Strategies that improve the continuity of care in general practice may reduce secondary care costs, particularly for the heaviest users of healthcare. Promoting continuity might also improve the experience of patients and those working in general practice.


  • We thank Therese Lloyd for helping to prepare the dataset for analysis, sharing code, and methodological advice; Will Warburton and Martin Roland for their helpful and insightful comments on an earlier version of this manuscript; and the four peer reviewers for feedback, which helped us to improve the manuscript. This study is based in part on data from the Clinical Practice Research Datalink obtained under license from the UK Medicines and Healthcare products Regulatory Agency. However, the interpretation and conclusions contained in this study are those of the authors alone.

  • Contributors: IB, AS, and SD had the idea for the study and submitted a major amendment to a previous Clinical Practice Research Datalink application to facilitate the research. IB, AS, and SD came up with the statistical analysis plan. IB and SD carried out the analysis. IB, SD, and AS drafted and finalised the paper. IB is the guarantor.

  • Funding: None received.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at and declare: all authors had financial support from The Health Foundation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: This study was approved by the Clinical Practice Research Datalink independent scientific advisory committee. This was secondary analysis of data submitted to the Clinical Practice Research Datalink, no patient consent forms were required to access this dataset.

  • Data sharing: The data controller of the data analysed is the Clinical Practice Research Datalink. Patient level data are available subject to their information governance requirements.

  • Transparency: The lead author (IB) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

View Full Text