02.02.17
Continuity of care reduces avoidable hospital admissions
Seeing the same GP more often can reduce avoidable hospital admissions for older patients, new research published in the British Medical Journal (BMJ) has found.
The research, conducted by the Health Foundation, analysed data from over 230,000 patient records for older people aged between 62 and 82, finding fewer hospital admissions for certain conditions when patients had greater continuity of care.
Patients who saw their most frequently seen GP two more times out of every 10 were associated with 9% fewer hospital admissions for manageable conditions as asthma, diabetes, influenza and pneumonia, compared with patients with low continuity of care. Those who experienced ‘high’ continuity of care experienced over 12% fewer admissions.
Adam Steventon, director of data analytics at the Health Foundation, said: “This research is important because it shows that patients who more regularly see the same GP experience fewer admissions to hospital.
“Improving continuity of care is not just what patients and GPs want; it could also help to reduce pressure on hospitals.”
Avoidable emergency admissions for manageable ‘ambulatory care sensitive conditions’ is a source of great cost for the health service, costing the NHS in England £1.42bn in 2009-10 when they accounted for around 15% of all hospital admissions.
The authors of the research concluded that strategies to improve the continuity of care in general practice “may reduce secondary care costs, particularly for the heaviest users of healthcare”.
However, the Health Foundation warned that an increasing focus on improving access to primary care, such as the extension of opening hours, may have the unintended effect of reducing continuity of care.
The Foundation noted that continuity of care is actually declining despite changes to the GP contract in 2014 introducing a named GP for all patients in England.
“An ongoing relationship between patients and GPs is important,” Steventon said. “However, general practices are under considerable pressure, and people are finding it increasingly difficult to see their preferred GP.
“There are a number of national policy initiatives focussed on improving primary care - any future initiatives should not lose sight of the crucial role of continuity of care.”
In an editorial linked to the research, researchers at the University of Bristol commented that seeing the same doctor “builds trust and a sense of mutual responsibility” between GPs and patients, while fragmented primary care might encourage patients to attend A&E instead. It also called for further initiatives by government, CCGs and GPs to promote and support continuity of care, such as GPs setting prompts on their booking systems.
Such initiatives would not only have benefits for patients but would improve the job satisfaction of GPs and reduce pressure on hospitals, the researchers concluded.
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