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Journal of General Internal Medicine

, Volume 25, Issue 8, pp 766–773 | Cite as

Regular Primary Care Lowers Hospitalisation Risk and Mortality in Seniors with Chronic Respiratory Diseases

  • Kristjana Einarsdóttir
  • David B. Preen
  • Jon D. Emery
  • Christopher Kelman
  • C. D’Arcy J. Holman
Original Research

Abstract

BACKGROUND

Exacerbations in chronic respiratory diseases (CRDs) are sensitive to seasonal variations in exposure to respiratory infectious agents and allergens and patient factors such as non-adherence. Hence, regular general practitioner (GP) contact is likely to be important in order to recognise symptom escalation early and adjust treatment.

OBJECTIVE

To examine the association of regularity of GP visits with all-cause mortality and first CRD hospitalisation overall and within groups of pharmacotherapy level in older CRD patients.

DESIGN

A retrospective cohort design using linked hospital, mortality, Medicare and pharmaceutical data for participant, exposure and outcome ascertainment. GP visit pattern was measured during the first 3 years of the observation period. Patients were then followed for a maximum of 11.5 years for ascertainment of hospitalisations and deaths.

PARTICIPANTS

We studied 108,455 patients aged ≥65 years with CRD in Western Australia (WA) during 1992–2006.

MAIN MEASURES

A GP visit regularity score (range 0–1) was calculated and divided into quintiles. A clinician consensus panel classified levels of pharmacotherapy. Cox proportional hazards models, controlling for multiple factors including GP visit frequency, were used to calculate hazard ratios and confidence intervals.

KEY RESULTS

Differences in survival curves and hospital avoidance pattern between the GP visit regularity quintiles were statistically significant (p = 0.0279 and p < 0.0001, respectively). The protective association between GP visit regularity and death appeared to be confined to the highest pharmacotherapy level group (P for interaction = 0.0001). Higher GP visit regularity protected against first CRD hospitalisation compared with the least regular quintile regardless of pharmacotherapy level (medium regular: HR = 0.84, 95% CI = 0.77–0.92; 2nd most regular: HR = 0.74, 95% CI = 0.67–0.82; most regular HR = 0.77, 95% CI = 0.68–0.86).

CONCLUSIONS

The findings indicate that regular and proactive ‘maintenance’ primary care, as distinct from ‘reactive’ care, is beneficial to older CRD patients by reducing their risks of hospitalisation and death.

KEY WORDS

chronic respiratory disease mortality hospitalisation primary care record linkage 

Notes

Acknowledgements

We thank the Australian Department of Health and Ageing, Medicare Australia, the Australian Electoral Commission, the WA Department of Health and the Registrar Generals Office of WA for providing the data used for this investigation. We are furthermore grateful to the Data Linkage Branch of the WA Department of Health for extracting and linking the data. We also thank the clinical consensus panel for designing guidelines for the pharmacotherapy level classification. The research was supported by a project grant from Australia’s National Health and Medical Research Council.

Conflict of Interest: None disclosed.

Supplementary material

11606_2010_1361_MOESM1_ESM.doc (36 kb)
ESM Table 1 Unadjusted association between GP visit regularity of patients with CRD and risk of death and first CRD hospitalisation, overall and by pharmacotherapy level. (DOC 36 kb)

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Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Kristjana Einarsdóttir
    • 1
  • David B. Preen
    • 1
  • Jon D. Emery
    • 2
  • Christopher Kelman
    • 3
  • C. D’Arcy J. Holman
    • 1
  1. 1.Centre for Health Services Research, School of Population Health M431The University of Western AustraliaPerthAustralia
  2. 2.School of Primary, Aboriginal and Rural Health CareThe University of Western AustraliaPerthAustralia
  3. 3.National Centre for Epidemiology and Population Health, Building 63Australian National UniversityAustralian Capital TerritoryAustralia

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