The impact of primary health care services, continuity of care and patterns of care on mortality and hospitalisation-related outcomes in residents of long-term care facilities: a comprehensive national evaluation.

INTRODUCTION

High-quality evidence on the benefits of primary care in long-term care (LTC) is lacking. This study investigated the effect of primary health care services, continuity of care and care patterns on the risk of mortality and hospitalisation-related outcomes in LTC facility residents.

METHODS

A retrospective cohort study of 358 354 residents of 2948 LTC facilities across Australia was conducted (1 January 2013-31 December 2019). Primary care services, general practitioner (GP) continuity of care, and care patterns were examined. One-year risk of all-cause/premature mortality and nine hospitalisation measures were investigated. Propensity-score-adjusted survival models were employed.

RESULTS

Residents with a care pattern inclusive of high preventive health services utilisation and low urgent after-hours attendances had lower risks of mortality [vs. high overall use, hazard ratio (HR) = 0.91, 95% confidence interval (CI) = 0.88-0.94; vs. high reactive use, HR = 0.91, 95% CI = 0.88-0.94] and most outcomes examined [e.g. fractures, subdistribution hazard ratio (sHRs) range = 0.90-0.91, 95% CI range = 0.84-0.97] compared to those with other care patterns. Residents who continued to see their usual GP had a lower risk of emergency department presentations (sHR = 0.92, 95% CI= 0.90-0.94), unplanned hospitalisations (sHR = 0.94, 95% CI= 0.92-0.96), falls (sHR = 0.89, 95% CI= 0.86-0.92), malnutrition (sHR = 0.88, 95% CI= 0.82-0.96), and dementia/delirium hospitalisations (sHR = 0.79, 95% CI= 0.72-0.87) than those who did not. Nurse practitioner attendances, optometrical services, comprehensive medication reviews, health assessments, management plans and podiatry attendances on their own were associated with lower premature mortality and some hospitalisation-related outcomes.

CONCLUSIONS

Care patterns focusing on prevention and disease management, GP continuity of care and certain primary care services can positively impact residents' health and outcomes in LTC facilities.