Primary care continuity and potentially avoidable hospitalization in persons with dementia

Area of Science:

• Geriatrics
• Health Services Research
• Public Health

Background:

• Potentially avoidable hospitalizations are a significant concern for community-dwelling persons with dementia.
• Primary care continuity is hypothesized to mitigate these hospitalizations.

Purpose of the Study:

• To measure the association between high primary care continuity and potentially avoidable hospitalizations in community-dwelling persons with dementia.
• To test the hypothesis that high primary care continuity is associated with fewer potentially avoidable hospitalizations.

Main Methods:

• Population-based retrospective cohort study (2012-2016) using health administrative data.
• Included 22,060 community-dwelling persons aged 65+ with dementia.
• Inverse probability of treatment weighting using propensity score analysis.

Main Results:

• High primary care continuity was associated with a reduced risk of ambulatory care sensitive conditions (ACSC) hospitalization (RR 0.82-0.87).
• High continuity also lowered the risk of 30-day hospital readmission (RR 0.81), overall hospitalization (RR 0.90), and emergency department visits (RR 0.92).
• Number needed to treat varied from 23 to 118 for different event types.

Conclusions:

• Increasing continuity with a primary care physician may reduce potentially avoidable hospitalizations in community-dwelling persons with dementia.
• This strategy could be implemented at a population-wide level to improve care for this demographic.