Browsing by Author "Chong, Christy C.E."

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    Determining the Association between Continuity of Primary Care and Acute Care Use among Adult Patients with Chronic Kidney Disease in Alberta
    (2021-06-22) Chong, Christy C.E.; Ronksley, Paul; Elliott, Meghan; Campbell, David; Aghajafari, Fariba
    Background: Acute care use is high among individuals with chronic kidney disease (CKD). It is unclear how relational continuity of primary care influences downstream acute care use. Aim: To determine if poor relational continuity of primary care is associated with higher rates of all-cause and potentially preventable acute care use among adults with CKD. This project had two objectives:1) To describe the relational continuity of primary care received among adults with CKD in Alberta over a 2-year period and,2) To determine if poor relational continuity of care is associated with higher rates of all-cause and CKD-related ACSC hospitalization and ED visits among adults with CKD.Design and Setting: A population-based retrospective cohort study of adults with stages 3 and 4 CKD and at least three visits to a primary care provider between April 1, 2011 to March 31, 2014 in Alberta, Canada.Method: Relational continuity was calculated using the Usual Provider Continuity index and descriptive statistics were used to summarize patient and acute care encounter characteristics. Adjusted rates (per 1,000 person-years) and incidence rate ratios for all-cause and CKD-related ambulatory care-sensitive condition (ACSC) hospitalizations and emergency department (ED) visits were estimated using negative binomial regression modelling. Results: Among 86,475 individuals with CKD, 51.3%, 30.0%, and 18.7% of patients had high, moderate, and poor continuity of primary care, respectively. There were 77,988 all-cause hospitalizations, 204,615 all-cause ED visits, 6,489 (8.3% of all hospitalizations) CKD-related ACSC hospitalizations, and 8,461 (4.1% of all ED visits) CKD-related ACSC ED visits during a median follow-up of 2.3 years. Rates of all-cause hospitalization and ED use increased with poorer continuity of primary care in a stepwise fashion across CKD stages. Poor continuity of primary care was also associated with higher rates of CKD-related ACSC hospitalization and ED visits, particularly among individuals with stage 3 CKD. Conclusion: Poor continuity of care is associated with increased acute care use and targeted strategies are needed to strengthen patient-provider relationships within primary care among those with CKD.