Continuity of primary care and healthcare costs
Background and rationale
Healthcare utilisation and expenditure increase substantially during the final months of life, with hospital admissions accounting for a large proportion of costs. While many people approaching the end of life wish to remain at home and avoid unnecessary hospitalisation, emergency admissions remain common and place considerable pressure on patients, families and healthcare services. Strengthening primary care has been identified as a key strategy for improving end-of-life care and reducing potentially avoidable hospital use.
Continuity of care is widely recognised as a core component of high-quality primary care. Seeing the same general practitioner (GP) over time may improve communication, trust, knowledge of patient preferences and proactive management of deteriorating health.
Our previous Policy Research Unit (PRU) study examining continuity of relational GP care found that higher continuity was associated with a lower likelihood of multiple emergency hospital admissions during the last three months of life. However, relatively little is known about the association between continuity of GP care and healthcare costs near the end of life. This project will build directly on those findings by examining the economic implications of continuity of care.
This project will examine whether continuity of GP care during the period 4-12 months before death is associated with formal healthcare costs during the final 90 days of life. By examining continuity before the last three months of life, the study aims to identify whether experiencing continuity of relational GP care earlier on may influence subsequent healthcare use.
The findings will provide evidence on whether policies designed to improve continuity of care could contribute to better outcomes and more efficient use of healthcare resources for people approaching the end of life.
Aims
- Primary aim: to examine the association between continuity of relational GP care in 12 to four months before death and formal healthcare costs (hospital, primary and community care) during the final 90 days of life.
- Secondary aim: to examine whether the association between continuity of relational GP care and formal healthcare costs varies across population subgroups, including diagnostic groups, multimorbidity, age, deprivation and other sociodemographic characteristics.
Methods
- This study will use a retrospective population-based cohort design based on linked routine healthcare data. The study population will consist of adults who died during the study period and had linked primary care, hospital and mortality records available through CPRD Aurum and Hospital Episode Statistics (HES).
- The primary exposure will be continuity of relational GP care during the period 12 to 4 months before death.
- The primary outcome will be healthcare costs (hospital, GP and community care costs) during the final 90 days of life. Secondary analyses will examine individual cost components, including emergency hospital admission costs, elective hospital admission costs, primary care costs and community care costs.
- Descriptive analyses will be used to characterise continuity of care, healthcare utilisation and costs across the study population. Multivariable regression models will then be used to estimate associations between continuity measures and outcomes while adjusting for demographic and clinical characteristics.
Impact
Policy relevance
Improving continuity of care remains a key objective of NHS primary care policy, yet evidence regarding its impact on healthcare costs and utilisation near the end of life is limited. This study will provide evidence on whether continuity of GP care earlier in the last year of life is associated with subsequent healthcare utilisation and expenditure.
The findings will be relevant to national and local policymakers seeking to strengthen community-based care and reduce avoidable hospital admissions.
The project aligns with broader NHS priorities around personalised care, integrated care and reducing pressure on acute hospital services. It will provide evidence that may inform workforce planning, continuity-promoting initiatives and future end-of-life care policy. By examining variation across population groups, the study may also identify opportunities to reduce inequalities and target interventions towards those most likely to benefit.
Principal Investigator
Senior Lecturer in Health Economics