CMAJ • November 20, 2007; 177 (11). doi:10.1503/cmaj.061615.
© 2007 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Résumé
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Ionescu-Ittu, R.
Right arrow Articles by Pineault, R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Ionescu-Ittu, R., MSc
Right arrow Articles by Pineault, R., MD PhD
Related Collections
Right arrow Other emergency medicine
Right arrow Other geriatric medicine
Right arrow Other family medicine
Right arrowRelated Article

Research

Continuity of primary care and emergency department utilization among elderly people

Raluca Ionescu-Ittu, MSc, Jane McCusker, MD DrPH, Antonio Ciampi, PhD, Alain-Michel Vadeboncoeur, MD, Danièle Roberge, PhD, Danielle Larouche, MSc, Josée Verdon, MD MSc and Raynald Pineault, MD PhD

From the Departments of Epidemiology, Biostatistics and Occupational Health (Ionescu-Ittu, McCusker, Ciampi) and Medicine (Verdon), McGill University, Montréal, Que.; Institut de Cardiologie de Montréal (Vadeboncoeur), Montréal, Que.; Hôpital Charles LeMoyne (Roberge, Larouche), Longueuil, Que.; and Direction de Santé Publique de Montréal (Pineault), Montréal, Que.

Correspondence to: Dr. Jane McCusker, Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital Center, 3830 Lacombe Ave., Montréal QC H3T 1M5; fax 514 734-2652; jane.mccusker{at}mcgill.ca

Background: 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.

Methods: 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 patients' 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.

Results: 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.

Interpretation: 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.


Related Article

Promoting continuity of care should be integral to any health care system
Walter Rosser, MD and Karen Schultz, MD
Can. Med. Assoc. J. 2007 177: 1385-1386. [Full Text] [PDF]



This article has been cited by other articles:


Home page
 Fam PractHome page
S. C. Yang, N. Zwar, S. Vagholkar, S. Dennis, and H. Redmond
Factors influencing general practice follow-up attendances of patients with complex medical problems after hospitalization
Fam. Pract., February 1, 2010; 27(1): 62 - 68.
[Abstract] [Full Text] [PDF]

Home page
 CMAJHome page
R. H. Glazier, J. Klein-Geltink, A. Kopp, and L. M. Sibley
Capitation and enhanced fee-for-service models for primary care reform: a population-based evaluation
Can. Med. Assoc. J., May 26, 2009; 180(11): E72 - E81.
[Abstract] [Full Text] [PDF]

Home page
 CMAJHome page
W. Rosser MD and K. Schultz MD
Promoting continuity of care should be integral to any health care system
Can. Med. Assoc. J., November 20, 2007; 177(11): 1385 - 1386.
[Full Text] [PDF]