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

BMC Family Practice

Paula Peremiquel-Trillas¹  Francesc Fina²  Manuel Medina²  Albert Mercadé²  Mireia Fàbregas²  Leonardo Méndez²  Ermengol Coma²  Mència Benítez³  Núria Mora⁴ 

[1] Preventive Medicine and Epidemiology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain;Unit of Molecular Epidemiology and Genetics in Infections and Cancer, IDIBELL, Catalan Institute of Oncology, L’Hospitalet de Llobregat, Barcelona, Spain;Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007, Barcelona, Spain;Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007, Barcelona, Spain;Equip d’Atenció Primària Gòtic, Institut Català de La Salut (ICS), Barcelona, Spain;Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007, Barcelona, Spain;Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain;

关键词: Continuity of patient care;    Primary health care;    Healthcare services utilization;    Patient care management;    Health service research;    Patient-physician relationship;    Population health management;   

DOI  :  10.1186/s12875-021-01414-y

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY