Continuity of care could save billions

New research shows patients who see the same GP are less likely to be admitted to hospital unnecessarily

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Patients who see the same GP are less likely to be admitted to hospital unnecessarily, potentially saving the healthcare system billions, new research shows.

While efforts had been made to improve access to primary care, those efforts might have had the unintended side effect of reducing continuity of care, the authors of the British study wrote.

In fact, continuity of care tended to be worse in larger practices, they found.

RACGP president Dr Bastian Seidel said the research reinforced the importance of what GPs had instinctively known – that the best care was delivered in small, quality, general practices.

“Last year there was a Dutch study indicating when you have a continuous relationship with your GP you live longer, and now this study says that continuity of care actually prevents hospital admissions – and quite significantly,” he said.

This new study, of over 230,000 English adults aged 62 to 82 years, found that patients were 12% less likely to be hospitalised with conditions that could have been managed in primary care compared with those with low continuity of care.

Even a medium level of continuity was associated with 9% fewer admissions for these conditions.

The effects were most pronounced for patients visiting 18 or more times over the two-year study period, they found.

Older patients were the focus because they tended to have the highest healthcare needs, comprising a high proportion of both GP visits and avoidable hospital admissions.

The authors found almost half of patients in smaller practices had high continuity of care, compared to less than a third in larger practices.

This indicated a need to reverse the trend of corporatisation of medicine happening in Australia, Dr Seidel said.

“We just have to make sure this research is now informing policy,” he said.

“Medicare rebates don’t reflect how a consultation should be reimbursed,  so the corporate model is just about getting more patients through in the same timeframe.

“That is not beneficial to patients, it is not beneficial to the practitioners and it’s certainly not working for the health system either.”

“It is ingrained in our profession to have a whole-of-life and a whole-of-family approach, so it is actually worthwhile looking at continuity of care [as a metric].”

The increased focus on multidisciplinary teams was also something to be careful of, to ensure it did not lead to less continuity and more fragmentation of care, Dr Seidel added.

In the meantime, it was important that GPs allowed themselves to spend more time with patients, he said.

“If we spend more time with our patients it’s going to enhance the doctor-patient relationship.

“Patients don’t want treatment, they want help, and that doesn’t mean sending them off to a multitude of investigations, blood tests, scans, admissions and referrals,” Dr Seidel said.

The RACGP estimated that preventing avoidable hospital presentations would save the healthcare system $2 billion per year in a submission to the government last year, Dr Seidel said.

BMJ 2017; online 1 February