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Relationship between Longitudinal Continuity of Primary Care and Likelihood of Death: Analysis of National Insurance Data

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  • Henri Leleu
  • Etienne Minvielle

Abstract

Background: Continuity of care (COC) is a widely accepted core principle of primary care and has been associated with patient satisfaction, healthcare utilization and mortality in many, albeit small, studies. Objective: To assess the relationship between longitudinal continuity with a primary care physician (PCP) and likelihood of death in the French general population. Design: Observational study based on reimbursement claims from the French national health insurance (NHI) database for salaried workers (2007–2010). Setting: Primary care. Patients: We extracted data on the number and pattern of visits made to a PCP and excluded all patients who did not visit a PCP at least twice within 6 months. We recorded age, gender, comorbidities, social status, and deaths. Main outcome measures: The primary endpoint was death by all causes. We measured longitudinal continuity of care (COC) with a PCP twice a year between 2007 and 2010, using the COC index developed by Bice and Boxerman. We introduced the COC index as time-dependent variables in a survival analysis after adjustment for age, gender and stratifying on comorbidities and social status. Results: A total of 325 742 patients were included in the analysis. The average COC index ranged from 0.74 (SD: 0.35) to 0.76 (0.35) (where 1.0 is perfect continuity). Likelihood of death was lower in patients with higher continuity (hazard ratio for an increase in 0.1 of continuity, adjusted for age, sex, and stratified on comorbidities and social status: 0.96 [0.95–0.96]). Conclusion: Higher longitudinal continuity was associated with a reduced likelihood of death.

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  • Henri Leleu & Etienne Minvielle, 2013. "Relationship between Longitudinal Continuity of Primary Care and Likelihood of Death: Analysis of National Insurance Data," PLOS ONE, Public Library of Science, vol. 8(8), pages 1-6, August.
    • Handle: RePEc:plo:pone00:0071669
    DOI: 10.1371/journal.pone.0071669
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    References listed on IDEAS

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    1. Rogers, J. & Curtis, P., 1980. "The concept and measurement of continuity in primary care," American Journal of Public Health, American Public Health Association, vol. 70(2), pages 122-127.
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    Cited by:

    1. Francesco Napolitano & Paola Napolitano & Luca Garofalo & Marianna Recupito & Italo F Angelillo, 2016. "Assessment of Continuity of Care among Patients with Multiple Chronic Conditions in Italy," PLOS ONE, Public Library of Science, vol. 11(5), pages 1-9, May.
    2. Chun-Pai Yang & Hao-Min Cheng & Mei-Chun Lu & Hui-Chu Lang, 2019. "Association between continuity of care and long-term mortality in Taiwanese first-ever stroke survivors: An 8-year cohort study," PLOS ONE, Public Library of Science, vol. 14(5), pages 1-13, May.
    3. Hjalmarsson, Linn & Kaiser, Boris & Bischof, Tamara, 2023. "The impact of physician exits in primary care: A study of practice handovers," Health Policy, Elsevier, vol. 135(C).
    4. Tamara Bischof & Boris Kaiser, 2021. "Who cares when you close down? The effects of primary care practice closures on patients," Health Economics, John Wiley & Sons, Ltd., vol. 30(9), pages 2004-2025, September.
    5. Suzanne E Bentler & Robert O Morgan & Beth A Virnig & Fredric D Wolinsky, 2014. "The Association of Longitudinal and Interpersonal Continuity of Care with Emergency Department Use, Hospitalization, and Mortality among Medicare Beneficiaries," PLOS ONE, Public Library of Science, vol. 9(12), pages 1-18, December.

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