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Primary care unattachment: impact on mortality, hospitalizations and costs
Abstract
Introduction
Primary care attachment is the formal or informal affiliation with a regular primary care clinician. In countries with near-universal primary care, a physician’s retirement typically results in the transition of care to another doctor. In many low- and middle-income countries, as well as the United States and Canada, this seamless transition often does not exist. A period of unattachment follows, during which the individual lacks primary care.
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 influences mortality, healthcare costs, and hospitalizations.
Results
A period of increased vulnerability was observed within the first 5 years of unattachment, associated with 85% higher odds of all-cause mortality compared with those attached for 15+ years. This association was amplified among multimorbid patients. Relative to long-term attached individuals without comorbidity, multimorbid patients exhibited approximately 5-fold higher all-cause mortality when stably attached, increasing to roughly 12-fold among those recently unattached. Cost and hospitalization outcomes exhibited similar patterns.
Conclusion
These findings carry crucial policy implications, underscoring the need for strategies that promote stable attachment, particularly for individuals with multimorbidity, and better patient support following the loss of a primary care physician.
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