BACKGROUND: Older people's preference is to age in place. Optimizing the delivery of high-quality home-based primary care for this growing population is a priority for healthcare systems worldwide. Provision of primary care is essential to support the health and wellbeing of the older population, yet there is a lack of high-quality evidence quantifying the effects of primary care services for the older population. This study aimed to examine the association of continuity of primary care and primary health care patterns on the risk of mortality and hospitalization in the older population. METHODS: A retrospective cohort study was conducted between 1 July 2016 and 31 December 2019 of 120,522 older people (≥ 65 years) living in the community receiving long-term care. Continuity of primary care and patterns of primary care service utilization on the risk of mortality and nine hospitalization-related outcomes were examined. Propensity score methods for confounding adjustment and survival analyses were employed. RESULTS: Compared with seeing a new primary care physician (n = 25,213, 30%), seeing a known primary care physician (n = 41,309, 49.1%) was associated with lower risks of hospitalizations ranging from 18% reduction for medication-related hospitalization (sHR = 0.82, 95% CI 0.74-0.91) to 28% reduction for fractures (sHR = 0.72, 95% CI 0.66-0.78). The care pattern of high preventive primary care service use (n = 34,021, 62.4%) was associated with lower risks of hospitalization ranging from 15% for ED presentations (sHR = 0.85, 95% CI 0.80-0.92) to 36% for pressure injury-related hospitalization (sHR = 0.64, 95% CI 0.52-0.80) compared to high overall primary care use (n = 5293, 9.7%). CONCLUSIONS: Care patterns focusing on prevention and disease management, and continuity of primary care were associated with more favorable health outcomes among older people aiming to age in place.
Caughey et al. (Tue,) studied this question.