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Kidney Week

Abstract: PO2311

Determining the Association Between Continuity of Primary Care and Acute Care Use Among Adults with CKD in Alberta, Canada

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Chong, Christy, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Campbell, David, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Elliott, Meghan J., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Aghajafari, Fariba, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Ronksley, Paul E., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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. We aimed 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.

Methods

We conducted 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. 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 models.

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.

Funding

  • Other NIH Support