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. 2010 Apr;65(4):421-8.
doi: 10.1093/gerona/glp188. Epub 2009 Dec 8.

Continuity of care with a primary care physician and mortality in older adults

Fredric D Wolinsky  1 , Suzanne E Bentler, Li Liu, John F Geweke, Elizabeth A Cook, Maksym Obrizan, Elizabeth A Chrischilles, Kara B Wright, Michael P Jones, Gary E Rosenthal, Robert L Ohsfeldt, Robert B Wallace
Affiliations

Continuity of care with a primary care physician and mortality in older adults

Fredric D Wolinsky et al. J Gerontol A Biol Sci Med Sci. 2010 Apr.

Abstract

Background: We examined whether older adults who had continuity of care with a primary care physician (PCP) had lower mortality.

Methods: Secondary analyses were conducted using baseline interview data (1993-1994) from the nationally representative Survey on Assets and Health Dynamics among the Oldest Old (AHEAD). The analytic sample included 5,457 self-respondents 70 years old or more who were not enrolled in managed care plans. AHEAD data were linked to Medicare claims for 1991-2005, providing up to 12 years of follow-up. Two time-dependent measures of continuity addressed whether there was more than an 8-month interval between any two visits to the same PCP during the prior 2-year period. The "present exposure" measure calculated this criterion on a daily basis and could switch "on" or "off" daily, whereas the "cumulative exposure" measure reflected the percentage of follow-up days, also on a daily basis allowing it to switch on or off daily, for which the criterion was met.

Results: Two thousand nine hundred and fifty-four (54%) participants died during the follow-up period. Using the cumulative exposure measure, 27% never had continuity of care, whereas 31%, 20%, 14%, and 8%, respectively, had continuity for 1%-33%, 34%-67%, 68%-99%, and 100% of their follow-up days. Adjusted for demographics, socioeconomic status, social support, health lifestyle, and morbidity, both measures of continuity were associated (p < .001) with lower mortality (adjusted hazard ratios of 0.84 for the present exposure measure and 0.31, 0.39, 0.46, and 0.62, respectively, for the 1%-33%, 34%-67%, 68%-99%, and 100% categories of the cumulative exposure measure).

Conclusion: Continuity of care with a PCP, as assessed by two distinct measures, was associated with substantial reductions in long-term mortality.

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