Positive findings from a British study support a long-held belief, aged care experts say.
Continual care with the same GP results in better health outcomes and fewer adverse events in patients with dementia, according to a large UK study.
The study, published in the British Journal of General Practice, found dementia patients who had a usual GP providing care had a 35% reduction in incidents of delirium compared to their peers, along with a 10% reduction in emergency hospital admission.
The one-year retrospective cohort study included about 9300 older people with dementia, with only 8% living in nursing homes.
University of Sydney dementia researcher Professor Susan Kurrle said that while continuity of care has always been generally accepted as best practice, there has been a lack of hard data.
“There’s a lot of things that we do that don’t have evidence for them,” she told The Medical Republic.
Comparisons between the 25% of patients with the lowest continuity of care and the 50% located in the middle suggested a dose-response relationship between continuity and better health outcomes.
Professor Kurrle said this confirmed what she had long seen in practice.
“It is really interesting to see the continuity of care [at work],” she said.
“There are people that have been going to the same GP for close to 30 years and it’s always obvious because those particular GPs pick things up and refer their patient on [very quickly].”
The BJGP researchers believe the better health outcomes for patients with dementia were likely related to a higher frequency of medication reviews.
“The results in the current study show higher continuity of GP care leads to better health outcomes, at least in part by reducing inappropriate medication,” they wrote.
“Higher continuity of GP care was also associated with fewer drugs deemed potentially inappropriate and with lower medication burden.”
Having proof of the effectiveness of medication reviews for dementia patients, according to Professor Kurrle, supports dementia organisations to better educate GPs.
Dementia is the second leading cause of death for Australians, and the number of people diagnosed with dementia is expected to double over the next 30 years.
While some residential care facilities do have a GP on staff, it is not yet common practice in the sector.
But it was harder to manage continuity of care once a person was admitted to a residential aged care facility, Professor Kurrle explained.
“There are facilities down the south coast where they have empty beds, but they can’t get a GP to take on the care of the residents, so they can’t admit new residents from hospitals,” she said.
Some residential care facilities employ dedicated GPs on their clinical teams in an effort to promote continuity of care.
“By including GPs as part of our in-home clinical teams, we want our residents to have access to medical care within our homes with the aim of reducing the need for unnecessary visits to hospital, through proactive and preventive care, combined with detailed advanced care directives and skilled palliative care,” a spokesperson for aged care vendor Bupa said.
Ultimately though, Professor Kurrle said more needed to be done to make aged care work more attractive and interesting for GPs.
