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Determining the Association Between Continuity of Primary Care and Acute Care Use in Chronic Kidney Disease: A
Christy Chong1,2, David Campbell1,2,3, Meghan Elliott1,2
1Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Insights
Poor primary care continuity in chronic kidney disease (CKD) patients increases acute care use. Strengthening patient-physician relationships and guideline-based prescribing are crucial for better outcomes.
Area of Science:
- Nephrology
- Primary Care Medicine
- Health Services Research
Background:
- High acute care utilization is prevalent in individuals with chronic kidney disease (CKD).
- The impact of primary care continuity on acute care use in CKD patients remains under-investigated.
Purpose of the Study:
- To investigate the association between primary care continuity and acute care utilization in CKD patients.
- To examine if poor continuity of care correlates with reduced prescriptions of guideline-recommended medications.
Main Methods:
- Population-based retrospective cohort study of 86,475 adults with stage 3-4 CKD in Alberta, Canada (2011-2014).
- Continuity of care assessed using the Usual Provider Continuity index.
- Negative binomial and logistic regression models used to estimate associations with hospitalizations, emergency department visits, and medication prescriptions.
Main Results:
- A stepwise increase in all-cause and CKD-related hospitalizations and emergency department visits was observed with decreasing continuity of care.
- Patients with poor continuity of care were less likely to receive statin prescriptions.
- 51.3% had high, 30.0% moderate, and 18.7% poor continuity of care.
Conclusions:
- Poor continuity of primary care is significantly associated with increased acute care use in patients with chronic kidney disease.
- Interventions aimed at enhancing patient-physician relationships and improving guideline-adherent prescribing are necessary.
Purpose:
Acute care use is high among individuals with chronic kidney disease (CKD). It is unclear how relational continuity of primary care influences downstream acute care use. We aimed to determine if poor continuity of care is associated with greater rates of acute care use and decreased prescriptions for guideline-recommended drugs.
Methods:
We conducted a population-based retrospective cohort study of adults with stage 3-4 CKD and ≥3 visits to a primary care clinician during the period April 1, 2011 to March 31, 2014 in Alberta, Canada. Continuity was calculated using the Usual Provider Continuity index. Descriptive statistics were used to summarize patient and acute care encounter characteristics. Adjusted rates and incidence rate ratios for all-cause and CKD-related ambulatory care-sensitive condition (ACSC) hospitalizations and emergency department (ED) visits were estimated using negative binomial regression. Adjusted odds ratios for prescription use were estimated by multivariable logistic regression.
Results:
Among 86,475 patients with CKD, 51.3%, 30.0%, and 18.7% had high, moderate, and poor continuity of care, respectively. There were 77,988 all-cause hospitalizations, 6,489 ACSC-related hospitalizations, 204,615 all-cause ED visits, and 8,461 ACSC-related ED visits during a median follow-up of 2.3 years. Rates of all-cause and ACSC hospitalization and ED use increased with poorer continuity of care in a stepwise fashion across CKD stages. Patients with poor continuity were less likely to be prescribed a statin.
Conclusions:
Poor continuity of care is associated with increased acute care use among patients with CKD. Targeted strategies that strengthen patient-physician relationships and guide physicians regarding guideline-recommended prescribing are needed.
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