Journal article
Continuity of care with a primary care physician and mortality in older adults
The journals of gerontology. Series A, Biological sciences and medical sciences, Vol.65(4), pp.421-428
04/2010
DOI: 10.1093/gerona/glp188
PMCID: PMC2844057
PMID: 19995831
Abstract
We examined whether older adults who had continuity of care with a primary care physician (PCP) had lower mortality. 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. 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). Continuity of care with a PCP, as assessed by two distinct measures, was associated with substantial reductions in long-term mortality.
Details
- Title: Subtitle
- Continuity of care with a primary care physician and mortality in older adults
- Creators
- Fredric D Wolinsky - Departments of Health Management and Policy and General Internal Medicine, The University of Iowa, 200 Hawkins Drive, E-205 General Hospital, Iowa City, IA 52242, USA. fredric-wolinsky@uiowa.eduSuzanne E BentlerLi LiuJohn F GewekeElizabeth A CookMaksym ObrizanElizabeth A ChrischillesKara B WrightMichael P JonesGary E RosenthalRobert L OhsfeldtRobert B Wallace
- Resource Type
- Journal article
- Publication Details
- The journals of gerontology. Series A, Biological sciences and medical sciences, Vol.65(4), pp.421-428
- DOI
- 10.1093/gerona/glp188
- PMID
- 19995831
- PMCID
- PMC2844057
- NLM abbreviation
- J Gerontol A Biol Sci Med Sci
- ISSN
- 1079-5006
- eISSN
- 1758-535X
- Publisher
- United States
- Grant note
- U01 AG009740 / NIA NIH HHS
- Language
- English
- Date published
- 04/2010
- Academic Unit
- Statistics and Actuarial Science; Pharmacy; Health Management and Policy; Epidemiology; Economics; Biostatistics; Nursing; College of Public Health; Injury Prevention Research Center; Public Policy Center (Archive); Internal Medicine
- Record Identifier
- 9983985922402771
Metrics
18 Record Views