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Table 2 Impact of continuity of primary care on hospital outcomes in aged care recipients

From: Impact of relational continuity of primary care in aged care: a systematic review

Author, Year

N

Outcome Measure

Continuity comparison

Hospitalisation

Emergency Department Presentations

Point Estimate

95% CI

P -value

Point Estimate

95% CI

P -value

Home care

 Jones, 2020 [56]

178,686

HR 1st admission/visit

High vs. low

0.94

0.92–0.96

NR

0.90

0.89–0.92

NR

Medium vs. low

0.96

0.94–0.98

NR

0.96

0.94–0.98

NR

 McGregor, 2018 [55]

246

Adjusted IRR admission/visit a

Pre-post HBPC

0.99

0.76–1.27

NR

0.91

0.72–1.15

NR

Continuing Care Retirement Community

 Bynum, 2011 [54]

2,468

IRR, all admissions b

24/7 physicians & NPs on-site vs limited on-site GP

0.55b

NA

 < 0.05

0.36b

NR

 < 0.001c

IRR, medical admissions b

0.41b

NA

0.002c

IRR, surgical admissions b

0.77b

NA

0.173c

Residential care

 Haines, 2020 [53]

NR (15 sites)

IRR, unplanned – Primary ITT analysis d

In house GP + changed nurse roles e vs Aust standard (“continuity model”)

0.74

0.56–0.96

0.024f

0.81g

0.66–1.01

0.06f

IRR, unplanned – contamination adjusted d

0.52

0.41–0.64

< 0.001

0.53

0.43–0.66

< 0.001

Length of hospital stay- IRR, Primary ITT analysis d

0.87

0.79–0.97

0.007f

NA

NA

NA

Length of hospital stay- IRR, contamination adjusted d

0.44

0.30–0.63

< 0.001

 Susman, 1989 [57]

335

Mean length of stay (days)

0 Physician visits

9.6 days

NR

 < 0.005h

NA

NA

NA

1 Physician visits

11.4 days

2 Physician visits

11.8 days

≥ 3 Physician visits

13.1 day

  1. Abbreviations: CI confidence interval, GP general practitioner, HBPC Home Based Primary Care, HR hazard ratio, IRR incidence rate ratio, ITT Intention-to-treat, NA not available (not calculable), NPs nurse practitioners, NR not reported, NS not significant
  2. a Adjusted for age, male, higher CHESS score, higher MAPLe score and living alone variables
  3. b Rate ratio of site D vs weighted average of control sites A-C, calculated by reviewers
  4. c P as reported by authors for comparison of rates across three control & one intervention sites
  5. d The primary analysis was ITT; the contamination adjusted ITT analysis adjusted for intervention sites according to whether a GP was employed for more than half of each nine-week block
  6. e Implementation difficulties due to GP recruitment affected four out of 15 sites
  7. f Results from pre-specified secondary analysis (with 54-week pre-trial retrospective period & 54-week post-trial follow-up in addition to 90-week trial period) were consistent
  8. g Unplanned hospital transfers
  9. h P < 0.005 for with vs without physician visits (length of stay dichotomous data 9.6 vs 12.5 days); measure of variation not reported