Re: 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
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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
Re: 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
As the Editor, Elizabeth Loder (https://doi.org/10.1136/bmj.j558), highlights, continuity of care is not a new concept. It is a basic concept in medicine and one that has made its resurgence in the United Kingdom (U.K.), the United States (U.S.), and around the world through different healthcare delivery system innovations such as patient centered medical homes and accountable care organizations. What is new is our growing understanding of just how impactful this basic concept of having a usual source of medical care for patients, particularly for those who are elderly, can be on health care costs, use, and quality.
Barker and colleagues (https://doi.org/10.1136/bmj.j84) examine the association between continuity of care and essentially unnecessary hospital admissions. Their person-level study shows that patients with a usual source of primary care are less likely to have unnecessary hospital admissions. These findings corroborate a study my colleagues and I conducted to examine the association between having a usual source of medical care and health care costs among Medicare patients in the United States (DOI:10.3768/rtipress.2016.rr.0026.1602). We observed a significant reduction in total Medicare costs among patients at practices where continuity of care was characterized as high compared to patients at practices characterized as having low continuity of care. This significant total cost reduction was driven by lower physician costs, lower ambulatory care sensitive conditions (ACSC) acute care inpatient hospital with and without 30 day post-acute care, and lower medical care costs with and without 30 day post-acute care.
While Barker and colleagues’ study is based in the U.K. using patient-level data and ours was based in the U.S. using patient-level data aggregated to the practice-level both emphasize the improvements in care that a usual source of primary care can provide elderly patients. Yet, despite this evidence, both countries along with others continue to experience a primary care physician shortage. As research continues to reinforce the benefits of a usual source of care to both patients and our health systems, many researchers such as myself are left wondering when a larger emphasis will be placed on ensuring that there is an adequate supply of primary care providers worldwide.
Rapid Response:
Re: 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
As the Editor, Elizabeth Loder (https://doi.org/10.1136/bmj.j558), highlights, continuity of care is not a new concept. It is a basic concept in medicine and one that has made its resurgence in the United Kingdom (U.K.), the United States (U.S.), and around the world through different healthcare delivery system innovations such as patient centered medical homes and accountable care organizations. What is new is our growing understanding of just how impactful this basic concept of having a usual source of medical care for patients, particularly for those who are elderly, can be on health care costs, use, and quality.
Barker and colleagues (https://doi.org/10.1136/bmj.j84) examine the association between continuity of care and essentially unnecessary hospital admissions. Their person-level study shows that patients with a usual source of primary care are less likely to have unnecessary hospital admissions. These findings corroborate a study my colleagues and I conducted to examine the association between having a usual source of medical care and health care costs among Medicare patients in the United States (DOI:10.3768/rtipress.2016.rr.0026.1602). We observed a significant reduction in total Medicare costs among patients at practices where continuity of care was characterized as high compared to patients at practices characterized as having low continuity of care. This significant total cost reduction was driven by lower physician costs, lower ambulatory care sensitive conditions (ACSC) acute care inpatient hospital with and without 30 day post-acute care, and lower medical care costs with and without 30 day post-acute care.
While Barker and colleagues’ study is based in the U.K. using patient-level data and ours was based in the U.S. using patient-level data aggregated to the practice-level both emphasize the improvements in care that a usual source of primary care can provide elderly patients. Yet, despite this evidence, both countries along with others continue to experience a primary care physician shortage. As research continues to reinforce the benefits of a usual source of care to both patients and our health systems, many researchers such as myself are left wondering when a larger emphasis will be placed on ensuring that there is an adequate supply of primary care providers worldwide.
Competing interests: No competing interests