Lisa L Cook1, Richard P Golonka2, Charles M Cook2, Robin L Walker2, Peter Faris2, Shannon Spenceley2, Richard Lewanczuk2, Robert Wedel2, Rebecca Love2, Cheryl Andres2, Susan D Byers2, Tim Collins2, Scott Oddie2. 1. Applied Research & Evaluation Services, Primary Health Care (L. Cook, C. Cook), Alberta Health Services; Faculty of Health Sciences (L. Cook, Spenceley), University of Lethbridge, Lethbridge, Alta.; Applied Research & Evaluation Services, Primary Health Care (Golonka), Alberta Health Services, Edmonton, Alta.; Applied Research & Evaluation Services, Primary Health Care (Walker), Alberta Health Services; Cumming School of Medicine (Walker, Faris), University of Calgary; Health Services Statistical & Analytics Methods, Analytics, Data Integration, Measurement & Reporting (Faris), Alberta Health Services, Calgary, Alta.; Enhancing Care in the Community (Lewanczuk), Alberta Health Services; Department of Medicine (Lewanczuk), University of Alberta, Edmonton, Alta.; Chinook Primary Care Network (Wedel, Byers, Collins); Primary Health Care Integration Network (Love), Alberta Health Services; Public & Primary Health Care (Andres), Alberta Health Services, Lethbridge, Alta.; Applied Research & Evaluation Services, Primary Health Care (Oddie), Alberta Health Services, Red Deer, Alta.; Faculty of Social Sciences (Oddie), University of Calgary, Calgary, Alta. Lisa.Cook@ahs.ca. 2. Applied Research & Evaluation Services, Primary Health Care (L. Cook, C. Cook), Alberta Health Services; Faculty of Health Sciences (L. Cook, Spenceley), University of Lethbridge, Lethbridge, Alta.; Applied Research & Evaluation Services, Primary Health Care (Golonka), Alberta Health Services, Edmonton, Alta.; Applied Research & Evaluation Services, Primary Health Care (Walker), Alberta Health Services; Cumming School of Medicine (Walker, Faris), University of Calgary; Health Services Statistical & Analytics Methods, Analytics, Data Integration, Measurement & Reporting (Faris), Alberta Health Services, Calgary, Alta.; Enhancing Care in the Community (Lewanczuk), Alberta Health Services; Department of Medicine (Lewanczuk), University of Alberta, Edmonton, Alta.; Chinook Primary Care Network (Wedel, Byers, Collins); Primary Health Care Integration Network (Love), Alberta Health Services; Public & Primary Health Care (Andres), Alberta Health Services, Lethbridge, Alta.; Applied Research & Evaluation Services, Primary Health Care (Oddie), Alberta Health Services, Red Deer, Alta.; Faculty of Social Sciences (Oddie), University of Calgary, Calgary, Alta.
Abstract
BACKGROUND: Continuity of care is a tenet of primary care. Our objective was to explore the relation between a change in access to a primary care physician and continuity of care. METHODS: We conducted a retrospective cohort study among physicians in a primary care network in southwest Alberta who measured access consistently between 2009 and 2016. We used time to the third next available appointment as a measure of access to physicians. We calculated the provider and clinic continuity, discontinuity and emergency department use based on the physicians' own panels. Physicians who improved, worsened or maintained their level of access within a given year were assessed in multilevel models to determine the association with continuity of care at the physician and clinic levels and the emergency department. RESULTS: We analyzed data from 190 primary care physicians. Physicians with improved access increased provider continuity by 6.8% per year, reduced discontinuity by 2.1% per year, and decreased emergency department encounters by 78 visits per 1000 patients per year compared to physicians with stable access. Physicians with worsening access had a 6.2% decrease in provider continuity and an increased number of emergency department encounters (64 visits per 1000 panelled patients per year) compared to physicians with stable access. INTERPRETATION: Changes in access to primary care can affect whether patients seek care from their own physician, from another clinic or at the emergency department. Improving access by reducing the delay in obtaining an appointment with one's primary care physician may be one mechanism to improve continuity of care. Copyright 2020, Joule Inc. or its licensors.
BACKGROUND: Continuity of care is a tenet of primary care. Our objective was to explore the relation between a change in access to a primary care physician and continuity of care. METHODS: We conducted a retrospective cohort study among physicians in a primary care network in southwest Alberta who measured access consistently between 2009 and 2016. We used time to the third next available appointment as a measure of access to physicians. We calculated the provider and clinic continuity, discontinuity and emergency department use based on the physicians' own panels. Physicians who improved, worsened or maintained their level of access within a given year were assessed in multilevel models to determine the association with continuity of care at the physician and clinic levels and the emergency department. RESULTS: We analyzed data from 190 primary care physicians. Physicians with improved access increased provider continuity by 6.8% per year, reduced discontinuity by 2.1% per year, and decreased emergency department encounters by 78 visits per 1000 patients per year compared to physicians with stable access. Physicians with worsening access had a 6.2% decrease in provider continuity and an increased number of emergency department encounters (64 visits per 1000 panelled patients per year) compared to physicians with stable access. INTERPRETATION: Changes in access to primary care can affect whether patients seek care from their own physician, from another clinic or at the emergency department. Improving access by reducing the delay in obtaining an appointment with one's primary care physician may be one mechanism to improve continuity of care. Copyright 2020, Joule Inc. or its licensors.
Authors: Peter Tammes; Sarah Purdy; Chris Salisbury; Fiona MacKichan; Daniel Lasserson; Richard W Morris Journal: Ann Fam Med Date: 2017-11 Impact factor: 5.166
Authors: Fidela S J Blank; Haiping Li; Philip L Henneman; Howard A Smithline; John S Santoro; Deborah Provost; Ann M Maynard Journal: J Emerg Nurs Date: 2005-04 Impact factor: 1.836