Title | Continuity of care with a primary care physician and mortality in older adults. |
Publication Type | Journal Article |
Year of Publication | 2010 |
Authors | Wolinsky, FD, Bentler, SE, Liu, L, Geweke, JF, Cook, EA, Obrizan, M, Chrischilles, EA, Wright, KB, Jones, MP, Rosenthal, GE, Ohsfeldt, RL, Wallace, RB |
Journal | J Gerontol A Biol Sci Med Sci |
Volume | 65 |
Issue | 4 |
Pagination | 421-8 |
Date Published | 2010 Apr |
ISSN Number | 1758-535X |
Call Number | newpubs20100519_Wolinsky.pdf |
Keywords | Aged, Continuity of Patient Care, Female, Health Services for the Aged, Humans, Male, Mortality, Physicians, Family |
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. |
DOI | 10.1093/gerona/glp188 |
User Guide Notes | |
Endnote Keywords | continuity of care/medicare/primary care physician/MORTALITY |
Endnote ID | 21950 |
Alternate Journal | J Gerontol A Biol Sci Med Sci |
Citation Key | 7443 |
PubMed ID | 19995831 |
PubMed Central ID | PMC2844057 |
Grant List | U01 AG009740 / AG / NIA NIH HHS / United States |