The association of continuity of family physician care with health care services utlization and costs in Newfoundland and Labrador

• Main Author: Knight, John Christopher
• Format: Thesis
• Language: English
• Published: Memorial University of Newfoundland 2011
• Subjects: Newfoundland
• Online Access: https://research.library.mun.ca/9556/; https://research.library.mun.ca/9556/1/Knight_JohnChristopher2.pdf

The objective of this study was to investigate the relationship of continuity of family physician (FP) care with health care services utilization and costs as well as the effect of age on these relationships in a general primary care sample in a Canadian province using health survey and administrative data. -- Samples from the provincial component of the Canadian Community Health Survey (CCHS) (2000/01) and the Medical Care Plan (MCP) provincial health insurance registry file (2003) were linked to four years of fee-for-service physician claims and inpatient hospital abstracts (1999-2002). Continuity of FP care was estimated by the Continuity of Care index (COC) using physician claims. Survey respondents/patients were classified into either low, medium, or high continuity depending on index value. Multi-variate regression (log-linear, ordinary least squares (OLS) or tobit, depending on outcome) was used to examine the association of continuity of care with health care services utilization and cost outcomes while controlling for predisposing, enabling and need factors as described in Andersen's behavioral model of health services use. -- The association of continuity of care with health care services utilization outcomes was investigated using both the CCHS (Phase I) and MCP (Phase II) samples while the association of continuity of care with health care cost outcomes was investigated using the MCP sample only. Using the MCP sample, two analyses involving health care services utilization and cost outcomes were conducted, a cross-sectional analysis where continuity of care and outcomes were measured over the same four-year period, and a longitudinal analysis where continuity was measured over a two-year period (1999-2000) and outcomes were measured over the following two years (2001-2002). -- Regression analysis showed that higher continuity of FP care was associated with small to moderate reductions in hospitalization for ambulatory-sensitive conditions (ACSCs) and hospital costs in both cross-sectional and ...