Older patients with long-term diseases (like heart disease, diabetes and dementia) are an important group. Their health problems are usually more complex than those of other patients and they often need more care from GPs. They are also more likely to be admitted to hospital as emergency cases. This can be distressing for these patients and costly for the NHS. As the number of older patients with long-term diseases rises, finding ways to provide better care for them in general practice becomes more important. Making it easier for such patients to see a GP who knows them well (improving continuity of care) may help. Research in other countries suggests that older patients with many long-term conditions who mainly see a GP who knows them well have lower levels of emergency hospital admission. We will use data from CPRD to find out whether this is also true in England. We also aim to find out whether patients who have better continuity of care live longer, and the best way of measuring continuity of care from GP records. The study findings will help NHS policymakers decide how much to focus on improving continuity of care for older medically complex patients.
Relational continuity of care between patients and GPs is an important aspect of primary care provision. There are however concerns that such continuity has declined, and will continue to do so in coming years as a result of increased service demands and macro level trends in primary care workforce. A better understanding of the relationship between relational continuity and important healthcare outcomes can help practices, patients and policymakers make better decisions about how much to prioritise relational continuity over other priorities (such as extended access). Specifically, a better understanding of whether continuity of care is associated with lower healthcare utilisation and better outcomes for older patients with multiple morbidities will become increasingly important as this group increases in number in coming years. We aim to use anonymised data from primary care medical records to quantify the association between continuity of care and two primary outcomes: rates of emergency hospitalisation and all-cause mortality. Using data from the Clinical Practice Research Datalink (CPRD) we will conduct a retrospective cohort analysis to quantify the strength of association between continuity of care at baseline and subsequent rates of hospitalization and death, using proportional hazard models adjusted for likely confounders, with subgroup analysis conducted for older patients with complex multimorbidity.
All cause mortality (PRIMARY); Routine hospitalisation (SECONDARY); Emergency hospitalisation (PRIMARY); GP consultation rate (SECONDARY); Primary care antibiotic prescription rate(SECONDARY).
Anas El Turabi - Chief Investigator - University of Cambridge
Martin Roland - Collaborator - University of Cambridge
Simon Griffin - Collaborator - University of Cambridge
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation