Determining the Association between Continuity of Primary Care and Acute Care Use among Adult Patients with Chronic Kidney Disease in Alberta
Date
2021-06-22
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Abstract
Background: 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. Aim: To determine if poor relational continuity of primary care is associated with higher rates of all-cause and potentially preventable acute care use among adults with CKD. This project had two objectives:1) To describe the relational continuity of primary care received among adults with CKD in Alberta over a 2-year period and,2) To determine if poor relational continuity of care is associated with higher rates of all-cause and CKD-related ACSC hospitalization and ED visits among adults with CKD.Design and Setting: A population-based retrospective cohort study of adults with stages 3 and 4 CKD and at least three visits to a primary care provider between April 1, 2011 to March 31, 2014 in Alberta, Canada.Method: Relational continuity was calculated using the Usual Provider Continuity index and descriptive statistics were used to summarize patient and acute care encounter characteristics. Adjusted rates (per 1,000 person-years) 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 modelling. Results: Among 86,475 individuals with CKD, 51.3%, 30.0%, and 18.7% of patients had high, moderate, and poor continuity of primary care, respectively. There were 77,988 all-cause hospitalizations, 204,615 all-cause ED visits, 6,489 (8.3% of all hospitalizations) CKD-related ACSC hospitalizations, and 8,461 (4.1% of all ED visits) CKD-related ACSC ED visits during a median follow-up of 2.3 years. Rates of all-cause hospitalization and ED use increased with poorer continuity of primary care in a stepwise fashion across CKD stages. Poor continuity of primary care was also associated with higher rates of CKD-related ACSC hospitalization and ED visits, particularly among individuals with stage 3 CKD. Conclusion: Poor continuity of care is associated with increased acute care use and targeted strategies are needed to strengthen patient-provider relationships within primary care among those with CKD.
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Ambulatory Care, Chronic Renal Insufficiency, Continuity of Patient Care, Hospitalization, Physician-Patient Relations, Primary Health Care
Citation
Chong, C. C. E. (2021). Determining the Association between Continuity of Primary Care and Acute Care Use among Adult Patients with Chronic Kidney Disease in Alberta (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.