Relationship between Longitudinal Continuity of Primary Care and Likelihood of Death: Analysis of National Insurance Data

BACKGROUND Continuity of care (COC) is a widely accepted core principle of primary care and has been associated with patient satisfaction, healthcare utilization and mortality in many, albeit small, studies. OBJECTIVE To assess the relationship between longitudinal continuity with a primary care physician (PCP) and likelihood of death in the French general population. DESIGN Observational study based on reimbursement claims from the French national health insurance (NHI) database for salaried workers (2007-2010). SETTING Primary care. PATIENTS We extracted data on the number and pattern of visits made to a PCP and excluded all patients who did not visit a PCP at least twice within 6 months. We recorded age, gender, comorbidities, social status, and deaths. MAIN OUTCOME MEASURES The primary endpoint was death by all causes. We measured longitudinal continuity of care (COC) with a PCP twice a year between 2007 and 2010, using the COC index developed by Bice and Boxerman. We introduced the COC index as time-dependent variables in a survival analysis after adjustment for age, gender and stratifying on comorbidities and social status. RESULTS A total of 325 742 patients were included in the analysis. The average COC index ranged from 0.74 (SD: 0.35) to 0.76 (0.35) (where 1.0 is perfect continuity). Likelihood of death was lower in patients with higher continuity (hazard ratio for an increase in 0.1 of continuity, adjusted for age, sex, and stratified on comorbidities and social status: 0.96 [0.95-0.96]). CONCLUSION Higher longitudinal continuity was associated with a reduced likelihood of death.