Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada.
Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; ICES uOttawa, Ottawa, Ontario, Canada.
J Am Med Dir Assoc. 2020 Dec;21(12):1951-1957. doi: 10.1016/j.jamda.2020.04.016. Epub 2020 Jun 22.
Older adults value and benefit from the long-standing relationship they have with their family physicians. This dynamic has not been researched in a long-term care (LTC, ie, nursing home) setting. We sought to determine the proportion of LTC residents who retain their community family physician within the first 180 days of LTC, and the resident, physician, and LTC home factors that may influence retention.
Population-based retrospective cohort study.
Individuals from Ontario, Canada, aged 60 years or older who were newly admitted to a LTC home between April 1, 2014 and March 31, 2017.
Residents were indexed upon LTC admission, and their data was linked across ICES databases. Residents were matched to their rostered family physician, and physician retention was defined as having at least 1 visit by their matched physician within 0 to 90 days and 90 to 180 days of LTC admission.
Out of 50,089 LTC residents, 12.1% retained their family physicians post-LTC admission. Resident factors associated with reduced odds of retention included physical impairment [odds ratio OR (95% confidence interval, CI) = 0.59 (0.42‒0.83)], cognitive impairment [0.39 (0.33‒0.47)], and a dementia diagnosis [0.80 (0.74‒0.86)]. Physician factors associated with lower retention included a greater distance from the LTC home to the family physician's clinic [30+ kilometers 0.41 (0.35‒0.48)], having a physician who is female [0.90 (0.83‒0.98)], an international medical graduate [0.89 (0.81‒0.97)] or someone who practices in a capitation-based Family Health Organization [0.86 (0.78‒0.95)]. Factors associated with greater odds of retention were residing in a rural LTC home [2.23 (1.78‒2.79)], having a rural family physician [1.70 (1.52‒1.90)], or a family physician who has billed LTC fee codes in the past year [2.64 (2.45‒2.85)].
Few LTC residents retained their family physician post-LTC admission, underscoring this healthcare transition as a breakdown point in relational continuity. Factors that influenced retention included resident health, LTC home geography, and family physician demographics and practice patterns.
老年人非常重视并受益于他们与家庭医生之间长期保持的关系。这一动态在长期护理（长期护理机构，即养老院）环境中尚未得到研究。我们试图确定在长期护理的头 180 天内，有多少长期护理居民保留了他们的社区家庭医生，以及可能影响保留率的居民、医生和长期护理机构的因素。
基于人群的回顾性队列研究。
2014 年 4 月 1 日至 2017 年 3 月 31 日期间，安大略省年龄在 60 岁或以上、新入住长期护理机构的个人。
居民在入住长期护理机构时被索引，并在安大略省临床评估科学研究所数据库中对其数据进行了链接。居民与他们的在册家庭医生相匹配，医生保留的定义是在入住长期护理机构后 0 至 90 天和 90 至 180 天内至少有一次由他们匹配的医生就诊。
在 50089 名长期护理居民中，有 12.1%的人在入住长期护理机构后保留了家庭医生。与保留家庭医生的可能性降低相关的居民因素包括身体损伤[比值比（OR）（95%置信区间，CI）=0.59（0.42-0.83）]、认知障碍[0.39（0.33-0.47）]和痴呆诊断[0.80（0.74-0.86）]。与保留率较低相关的医生因素包括与长期护理机构的家庭医生诊所的距离较远[30 公里以上 0.41（0.35-0.48）]、医生为女性[0.90（0.83-0.98）]、国际医学毕业生[0.89（0.81-0.97)]或在基于人头的家庭健康组织中执业的医生[0.86（0.78-0.95）]。与保留率较高相关的因素包括居住在农村长期护理机构[2.23（1.78-2.79）]、有农村家庭医生[1.70（1.52-1.90）]或家庭医生在过去一年中开长期护理费用代码[2.64（2.45-2.85）]。
很少有长期护理居民在入住长期护理机构后保留了家庭医生，这突显了这种医疗保健过渡是关系连续性的一个中断点。影响保留率的因素包括居民健康、长期护理机构地理位置以及家庭医生的人口统计学和实践模式。
