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Primary Care Unattachment; Impact on Mortality, Hospitalizations and Costs

Abstract

Background:

Primary care attachment, defined as a patient’s formal or informal affiliation with a regular primary care provider, is a cornerstone of many healthcare systems. Yet, growing system pressures have left many individuals unattached, navigating the system alone.

Methods:

This population-based retrospective cohort study of 12,726,325 Ontarians uses health administrative data to examine how the duration of attachment and unattachment to a family physician influences mortality, healthcare costs, and hospitalizations.

Findings:

A critical vulnerability period was evident in the first five years after loss of a family physician, during which patient outcomes worsened. Most notably, between March 2023 and April 2024, odds of all-cause mortality were up to 85% higher (Odds Ratio [OR]: 1·85; 95% CI: 1·77-1·94) and premature mortality up to 117% higher (OR: 2·17; 95% CI: 2·05-2·29) than among those attached to a family physician for 15+ years. This effect peaked an order of magnitude higher among the first five years of unattachment for multimorbid patients, whose all-cause mortality risk was up to 12-fold that of healthy, stably attached individuals (OR: 12·00; 95% CI: 10·70-13·46), versus a 5-fold increase among comparable multimorbid patients attached 15+ years (OR: 5·09; 95% CI: 4·76–5·43). Cost- and hospitalization-related outcomes exhibited similar patterns, with the most adverse associations seen among multimorbid individuals with short-term unattachment.

Interpretation:

These findings carry crucial policy implications, underscoring the need for strategies that promote stable attachment to family physicians, particularly for individuals with multi-morbidity, and better patient support following the loss of a primary care clinician. Funding: This project was funded by the Ontario Ministry of Health via the Innovations Strengthening Primary Health Care through Research (INSPIRE-PHC) Applied Health Research Question (AHRQ) Program.

[Keywords]primary care,Patient attachment,Unattachment duration,Comorbidity,Healthcare utilization,Healthcare costs,Healthcare policy[/keywords]