Abstract
Objective
Older adults value and benefit from the long-standing relationship they have with
their family physicians. This dynamic has not been researched in a long-term care
(LTC, ie, nursing home) setting. We sought to determine the proportion of LTC residents
who retain their community family physician within the first 180 days of LTC, and
the resident, physician, and LTC home factors that may influence retention.
Design
Population-based retrospective cohort study.
Setting and Participants
Individuals from Ontario, Canada, aged 60 years or older who were newly admitted to
a LTC home between April 1, 2014 and March 31, 2017.
Methods
Residents were indexed upon LTC admission, and their data was linked across ICES databases.
Residents were matched to their rostered family physician, and physician retention
was defined as having at least 1 visit by their matched physician within 0 to 90 days
and 90 to 180 days of LTC admission.
Results
Out of 50,089 LTC residents, 12.1% retained their family physicians post-LTC admission.
Resident factors associated with reduced odds of retention included physical impairment
[odds ratio OR (95% confidence interval, CI) = 0.59 (0.42‒0.83)], cognitive impairment
[0.39 (0.33‒0.47)], and a dementia diagnosis [0.80 (0.74‒0.86)]. Physician factors
associated with lower retention included a greater distance from the LTC home to the
family physician's clinic [30+ kilometers 0.41 (0.35‒0.48)], having a physician who
is female [0.90 (0.83‒0.98)], an international medical graduate [0.89 (0.81‒0.97)]
or someone who practices in a capitation-based Family Health Organization [0.86 (0.78‒0.95)].
Factors associated with greater odds of retention were residing in a rural LTC home
[2.23 (1.78‒2.79)], having a rural family physician [1.70 (1.52‒1.90)], or a family
physician who has billed LTC fee codes in the past year [2.64 (2.45‒2.85)].
Conclusions and Implications
Few LTC residents retained their family physician post-LTC admission, underscoring
this healthcare transition as a breakdown point in relational continuity. Factors
that influenced retention included resident health, LTC home geography, and family
physician demographics and practice patterns.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the American Medical Directors AssociationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Relational continuity from the patient perspective: Comparison of primary healthcare evaluation instruments.Healthcare Policy. 2011; 7: 124
- The association between continuity of care and outcomes: A systematic and critical review.J Evaluation Clin Pract. 2010; 16: 947-956
- What do we know about patients' perceptions of continuity of care? A meta-synthesis of qualitative studies.Int J Qual Health Care. 2011; 24: 39-48
- Relationship continuity: When and why do primary care patients think it is safer?.Br J Gen Pract. 2014; 64: e758-e764
- Continuity and the costs of care for chronic disease.JAMA Intern Med. 2014; 174: 742-748
- Financial implications of the continuity of primary care.Permanente J. 2015; 194
- Continuity of Care With Family Medicine Physicians: Why It Matters [Internet]. Ottawa, ON: CIHI; 2015.(Available at:)https://secure.cihi.ca/free_products/UPC_ReportFINAL_EN.pdfDate accessed: December 13, 2019
- Organizational aspects of primary care related to avoidable hospitalization: A systematic review.Fam Pract. 2014; 31: 502-516
- The association between multimorbidity and hospitalization is modified by individual demographics and physician continuity of care: A retrospective cohort study.BMC Health Serv Res. 2016; 16: 154
- 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.BMJ. 2017; 356: j84
- A longitudinal examination of continuity of care and avoidable hospitalization: Evidence from a universal coverage health care system.Arch Intern Med. 2010; 170: 1671-1677
- Medication administration errors for older people in long-term residential care.BMC Geriat. 2011; 11: 82
- Quantitative exploration of medication errors among older people: A systematic review.Drugs Ther Perspect. 2018; 34: 129-137
- Drug administration to the wrong nursing home residents reported to the Québec poison center: A retrospective study.J Am Med Dir Assoc. 2018; 19: 891-895
- The revolving door of rehospitalization from skilled nursing facilities.Health Affairs. 2010; 29: 57-64
- Use of emergency departments by older people from residential care: A population based study.Age Ageing. 2009; 38: 314-318
- Recent health care transitions and emergency department use by chronic long term care residents: A population-based cohort study.J Am Med Dir Assoc. 2012; 13: 202-206
- An Assessment of Handover culture and preferred information in the transitions of care of elderly patients.Cureus. 2019; 11: 7
- The consequences of poor communication during transitions from hospital to skilled nursing facility: A qualitative study.J Am Geriatr Soc. 2013; 61: 1095-1102
- Transitions to long-term and residential care among older Canadians.Health Reports. 2018; 29: 13-23
- Long-term care providers and services users in the United States, 2015-2016.(Available at:)https://stacks.cdc.gov/view/cdc/76253Date accessed: December 16, 2019
- Changes in the older resident care home population between 2001 and 2011. Office for National Statistics. 2016.(Available at:)
- Effect of continuity of care on drug-drug interactions.Med Care. 2017; 55: 744-751
- Relationship between continuity of ambulatory care and risk of emergency department episodes among older adults.Ann Emerg Med. 2017; 69: 407-415
- Association between continuity of care in Swedish primary care and emergency services utilisation: A population-based cross-sectional study.Scand J Prim Health Care. 2017; 35: 113-119
- Does continuity of care with a family physician reduce hospitalizations among older adults?.J Health Serv Res Policy. 2006; 11: 196-201
- Continuity of care and health care utilization in older adults with dementia in fee-for-service Medicare.JAMA Intern Med. 2016; 176: 1371-1378
- Continuity of primary care and emergency department utilization among elderly people.CMAJ. 2007; 177: 1362-1368
- Improving continuity of care reduces emergency department visits by long-term care residents.J Am Board Fam Med. 2016; 29: 201-208
- Characteristics of general practice care: What do senior citizens value? A qualitative study.BMC Geriatr. 2010; 10: 80
- Older patients and their GPs: Shared decision making in enhancing trust.Br J Gen Pract. 2014; 64: e709-e718
- Do-Not-resuscitate and do-not-hospitalize orders in nursing homes: who gets them and do they make a difference?.J Am Med Dir Assoc. 2019; 20 (1169–174.e1)
- Scaling ADLs within the MDS.J Gerontol Ser A. 1999; 54: M546-M553
- MDS cognitive performance scale.J Gerontol. 1994; 49: M174-M182
- Validation of the minimum data set cognitive performance scale: Agreement with the mini-mental state examination.J Gerontol Ser A Biol Sci Med Sci. 1995; 50: M128-M133
- Predictors of relational continuity in primary care: Patient, provider and practice factors.BMC Fam Pract. 2013; 14: 72
- Geographic distribution of physicians in Canada: Beyond how many and where. 2005. Ottawa: Canadian Institute for Health Information.(Available at:)https://secure.cihi.ca/free_products/Geographic_Distribution_of_Physicians_FINAL_e.pdfDate accessed: December 18, 2019
- Practice features associated with patient-reported accessibility, continuity, and coordination of primary health care.Ann Fam Med. 2008; 6: 116-123
- Physician practice patterns in nursing homes.J Am Med Dir Assoc. 2007; 8: 558-567
- Rewards and challenges of family practice: Web-based survey using the Delphi method.Can Fam Phys. 2007; 53: 277-286
- Which positive factors determine the GP satisfaction in clinical practice? A systematic literature review.BMC Fam Pract. 2016; 17: 133
- Long-Term Care Homes Act Ontario Regulation 79/10. 2010 (ON)
- Rapid appraisal of barriers to the diagnosis and management of patients with dementia in primary care: A systematic review.BMC Fam Pract. 2010; 11: 52
- Primary care for elderly people: Why do doctors find it so hard?.Gerontologist. 2002; 42: 835-842
- Physical symptoms and physician-experienced difficulty in the physician–patient relationship.Ann Intern Med. 2001; 134: 897-904
- Paying for primary care: A cross-sectional analysis of cost and morbidity distributions across primary care payment models in Ontario Canada.Soc Sci Med. 2015; 124: 18-28
- Paying for primary care: The factors associated with physician self-selection into payment models.Health Economics. 2015; 24: 1229-1942
- Primary care physicians in ten countries report challenges caring for patients with complex health needs.Health Affairs. 2015; 34: 2104-2112
- The implications of the feminization of the primary care physician workforce on service supply: A systematic review.Hum Resources Health. 2014; 12: 32
- Education in long-term care for family medicine residents: Description of an integrated program.Can Fam Phys. 2011; 57: e288-e291
Article info
Publication history
Published online: June 22, 2020
Footnotes
C.L. and P.T. share senior authorship.
This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). This work was also supported by the Ontario QUILT (QUality for Individuals who require Long-Term support) Network (MOHLTC Grant ID no. 255); Canadian Institutes of Health Research (Grant no. 137008); the Government of Ontario through the Ontario Centre for Learning, Research and Innovation in Long-Term Care hosted at Bruyère; the Bruyère Center for Individualized Health. Parts of this material are based on data and/or information compiled and provided by the MOHLTC, CIHI, and IMS Brogan. The analyses, conclusions, opinions and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred. We thank IMS Brogan Inc. for use of their Drug Information Database.
The authors declare no conflicts of interest.
Identification
Copyright
© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
