Association between continuity of care in Swedish primary care and emergency services utilisation: a population-based cross-sectional study

OBJECTIVE The primary objective of this study was to determine the association between longitudinal continuity of care (CoC) in Swedish primary care (PC) and emergency services (ES) utilisation. STUDY DESIGN A cross-sectional analysis of longitudinal population data. SETTING PC centres, out-of-hours PC facilities and emergency departments (EDs) in Blekinge County in southern Sweden. SUBJECTS People of all ages who lived in Blekinge County and who had made two or more visits per year to a general practitioner (GP) during office hours from 1 January 2012 to 31 December 2014. MAIN OUTCOME MEASURE ES utilisation. RESULTS Eight-thousand one-hundred and eighty-five people were included in the study. CoC was quantified using three different indices-Usual Provider of Care index (UPC), Continuity of Care index (CoCI), and Sequential Continuity index (SECON). The CoC that the PC centres could offer their enrolled patients varied significantly between the different centres, ranging from 0.23-0.57 for UPC, 0.12-0.43 for CoCI, and 0.25-0.52 for SECON. Association between the three CoC indices and ES utilisation was computed as an incidence rate ratio which ranged between 0.50 and 0.59. CONCLUSION Longitudinal CoC was shown to have a negative association with ES utilisation. The association was significant and of a magnitude that implies clinical relevance. Computed incidence rate ratios suggest that patients with the lowest CoC had twice as many ES visits compared to patients with the highest CoC.