Continuity of primary care and emergency department utilization among elderly people

TLDR

Elderly (65+) constitute a rapidly expanding segment of emergency department users. The study examined whether primary‑care accessibility and continuity influence emergency‑department utilization among older adults in urban and rural settings. A cross‑sectional analysis of 95,173 Quebec residents aged 65+ from 2000–2001 used administrative data to assess demographics, comorbidity, ED visit rates, physician access, and continuity of care. After adjustment, absence of a primary physician and lower continuity were linked to higher ED use (RR 1.45–1.46), with rural residence, low socioeconomic status, and higher physician‑population ratios also increasing risk, and continuity exerting a stronger protective effect in urban areas.

Abstract

<b>Background:</b> People aged 65 years or more represent a growing group of emergency department users. We investigated whether characteristics of primary care (accessibility and continuity) are associated with emergency department use by elderly people in both urban and rural areas. <b>Methods:</b> We conducted a cross-sectional study using information for a random sample of 95 173 people aged 65 years or more drawn from provincial administrative databases in Quebec for 2000 and 2001. We obtained data on the patients9 age, sex, comorbidity, rate of emergency department use (number of days on which a visit was made to an amergency department per 1000 days at risk [i.e., alive and not in hospital] during the 2-year study period), use of hospital and ambulatory physician services, residence (urban v. rural), socioeconomic status, access (physician: population ratio, presence of primary physician) and continuity of primary care. <b>Results:</b> After adjusting for age, sex and comorbidity, we found that an increased rate of emergency department use was associated with lack of a primary physician (adjusted rate ratio [RR] 1.45, 95% confidence interval [CI] 1.41–1.49) and low or medium (v. high) levels of continuity of care with a primary physician (adjusted RR 1.46, 95% CI 1.44–1.48, and 1.27, 95% CI 1.25–1.29, respectively). Other significant predictors of increased use of emergency department services were residence in a rural area, low socioeconomic status and residence in a region with a higher physician:population ratio. Among the patients who had a primary physician, continuity of care had a stronger protective effect in urban than in rural areas. <b>Interpretation:</b> Having a primary physician and greater continuity of care with this physician are factors associated with decreased emergency department use by elderly people, particularly those living in urban areas.