The association of continuity of family physician care with health care services utlization and costs in Newfoundland and Labrador

Knight, John Christopher (2011) The association of continuity of family physician care with health care services utlization and costs in Newfoundland and Labrador. Doctoral (PhD) thesis, Memorial University of Newfoundland.

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Abstract

The objective of this study was to investigate the relationship of continuity of family physician (FP) care with health care services utilization and costs as well as the effect of age on these relationships in a general primary care sample in a Canadian province using health survey and administrative data. -- Samples from the provincial component of the Canadian Community Health Survey (CCHS) (2000/01) and the Medical Care Plan (MCP) provincial health insurance registry file (2003) were linked to four years of fee-for-service physician claims and inpatient hospital abstracts (1999-2002). Continuity of FP care was estimated by the Continuity of Care index (COC) using physician claims. Survey respondents/patients were classified into either low, medium, or high continuity depending on index value. Multi-variate regression (log-linear, ordinary least squares (OLS) or tobit, depending on outcome) was used to examine the association of continuity of care with health care services utilization and cost outcomes while controlling for predisposing, enabling and need factors as described in Andersen's behavioral model of health services use. -- The association of continuity of care with health care services utilization outcomes was investigated using both the CCHS (Phase I) and MCP (Phase II) samples while the association of continuity of care with health care cost outcomes was investigated using the MCP sample only. Using the MCP sample, two analyses involving health care services utilization and cost outcomes were conducted, a cross-sectional analysis where continuity of care and outcomes were measured over the same four-year period, and a longitudinal analysis where continuity was measured over a two-year period (1999-2000) and outcomes were measured over the following two years (2001-2002). -- Regression analysis showed that higher continuity of FP care was associated with small to moderate reductions in hospitalization for ambulatory-sensitive conditions (ACSCs) and hospital costs in both cross-sectional and longitudinal analyses. Analysis by age group provided evidence that reductions increased with age and does-response relationships where reductions in these outcomes became larger with increasing continuity level, were often seen at older age groups. For example, in the 75+ age group, reductions in hospitalizations for ACSCs were 25.8% for medium continuity and 35.0% for low continuity, relative to high continuity (longitudinal analysis); while reductions in hospital cost were 11.7% for medium continuity and 19.3% for low continuity (cross-sectional analysis). Higher continuity of care was also associated with reductions in total hospitalization, specialist utilization/costs, and total physician costs in cross-sectional analyses. -- The study provides strong evidence that continuity of FP care results in reduced hospitalization for ambulatory-sensitive chronic illness and hospital costs in a universally-insured health care system, probably through improvements in prevention and/or management of chronic illness, which may take on increased importance in older individuals. Although evidence of associations of continuity of FP care with the other health care utilization and cost outcomes was found, the lack of directional associations seen in the longitudinal analysis preclude us from concluding that it is continuity of care which is driving the observed changes in these other outcomes. Thus, alternate explanations for the association of continuity of care with these other outcomes cannot be ruled out. -- A modified model of health services use incorporating a visit-based measure of continuity of FP care and accounting for FP utilization, based on Andersen's model, illustrating the main study findings is provided.

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