Cook Lisa L, Golonka Richard P, Cook Charles M, Walker Robin L, Faris Peter, Spenceley Shannon, Lewanczuk Richard, Wedel Robert, Love Rebecca, Andres Cheryl, Byers Susan D, Collins Tim, Oddie Scott
Applied Research & Evaluation Services, Primary Health Care (L. Cook, C. Cook), Alberta Health Services; Faculty of Health Sciences (L. Cook, Spenceley), University of Lethbridge, Lethbridge, Alta.; Applied Research & Evaluation Services, Primary Health Care (Golonka), Alberta Health Services, Edmonton, Alta.; Applied Research & Evaluation Services, Primary Health Care (Walker), Alberta Health Services; Cumming School of Medicine (Walker, Faris), University of Calgary; Health Services Statistical & Analytics Methods, Analytics, Data Integration, Measurement & Reporting (Faris), Alberta Health Services, Calgary, Alta.; Enhancing Care in the Community (Lewanczuk), Alberta Health Services; Department of Medicine (Lewanczuk), University of Alberta, Edmonton, Alta.; Chinook Primary Care Network (Wedel, Byers, Collins); Primary Health Care Integration Network (Love), Alberta Health Services; Public & Primary Health Care (Andres), Alberta Health Services, Lethbridge, Alta.; Applied Research & Evaluation Services, Primary Health Care (Oddie), Alberta Health Services, Red Deer, Alta.; Faculty of Social Sciences (Oddie), University of Calgary, Calgary, Alta.
CMAJ Open. 2020 Nov 16;8(4):E722-E730. doi: 10.9778/cmajo.20200014. Print 2020 Oct-Dec.
Continuity of care is a tenet of primary care. Our objective was to explore the relation between a change in access to a primary care physician and continuity of care.
We conducted a retrospective cohort study among physicians in a primary care network in southwest Alberta who measured access consistently between 2009 and 2016. We used time to the third next available appointment as a measure of access to physicians. We calculated the provider and clinic continuity, discontinuity and emergency department use based on the physicians' own panels. Physicians who improved, worsened or maintained their level of access within a given year were assessed in multilevel models to determine the association with continuity of care at the physician and clinic levels and the emergency department.
We analyzed data from 190 primary care physicians. Physicians with improved access increased provider continuity by 6.8% per year, reduced discontinuity by 2.1% per year, and decreased emergency department encounters by 78 visits per 1000 patients per year compared to physicians with stable access. Physicians with worsening access had a 6.2% decrease in provider continuity and an increased number of emergency department encounters (64 visits per 1000 panelled patients per year) compared to physicians with stable access.
Changes in access to primary care can affect whether patients seek care from their own physician, from another clinic or at the emergency department. Improving access by reducing the delay in obtaining an appointment with one's primary care physician may be one mechanism to improve continuity of care.
连续性医疗是初级医疗的一项原则。我们的目标是探讨获得初级保健医生服务的变化与连续性医疗之间的关系。
我们对阿尔伯塔省西南部一个初级保健网络中的医生进行了一项回顾性队列研究，这些医生在2009年至2016年期间持续测量了可及性。我们将距离下一次可预约的时间用作衡量获得医生服务的指标。我们根据医生自己的患者群计算了提供者连续性、间断性以及急诊科就诊情况。在多级模型中对在给定年份内可及性改善、恶化或保持不变的医生进行评估，以确定在医生和诊所层面以及急诊科与连续性医疗的关联。
我们分析了190名初级保健医生的数据。与可及性稳定的医生相比，可及性改善的医生每年的提供者连续性提高了6.8%，间断性降低了2.1%，每1000名患者每年的急诊科就诊次数减少了78次。与可及性稳定的医生相比，可及性恶化的医生的提供者连续性下降了6.2%，急诊科就诊次数增加（每1000名登记患者每年64次）。
获得初级保健服务的变化会影响患者是向自己的医生、其他诊所还是急诊科寻求治疗。通过减少预约初级保健医生的延迟来改善可及性可能是提高连续性医疗的一种机制。
