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Health Serv Res. 2019 Oct 9. doi: 10.1111/1475-6773.13211. [Epub ahead of print]

Impact of family practice continuity of care on unplanned hospital use for people with serious mental illness.

Author information

1
Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Vic., Australia.
2
Centre for Health Economics, University of York, York, UK.
3
Department of Health Sciences, University of York, York, UK.
4
Department of Primary Care, University of Southampton, Southampton, UK.
5
Hull York Medical School, York, UK.
6
Bradford District Care, NHS Foundation Trust, Bradford, UK.
7
Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK.
8
Clinical Practice Research Datalink, London, UK.
9
Health Professions Education Unit, Hull York Medical School, York, UK.
10
Service User, York, North Yorkshire, UK.

Abstract

OBJECTIVE:

To investigate whether continuity of care in family practice reduces unplanned hospital use for people with serious mental illness (SMI).

DATA SOURCES:

Linked administrative data on family practice and hospital utilization by people with SMI in England, 2007-2014.

STUDY DESIGN:

This observational cohort study used discrete-time survival analysis to investigate the relationship between continuity of care in family practice and unplanned hospital use: emergency department (ED) presentations, and unplanned admissions for SMI and ambulatory care-sensitive conditions (ACSC). The analysis distinguishes between relational continuity and management/ informational continuity (as captured by care plans) and accounts for unobserved confounding by examining deviation from long-term averages.

DATA COLLECTION/EXTRACTION METHODS:

Individual-level family practice administrative data linked to hospital administrative data.

PRINCIPAL FINDINGS:

Higher relational continuity was associated with 8-11 percent lower risk of ED presentation and 23-27 percent lower risk of ACSC admissions. Care plans were associated with 29 percent lower risk of ED presentation, 39 percent lower risk of SMI admissions, and 32 percent lower risk of ACSC admissions.

CONCLUSIONS:

Family practice continuity of care can reduce unplanned hospital use for physical and mental health of people with SMI.

KEYWORDS:

continuity of care; family practice; hospital care; serious mental illness

PMID:
31598965
DOI:
10.1111/1475-6773.13211

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