Continuity of primary care helps chronic kidney disease patients

Relationships key to managing complexities, comorbidities, study finds.

Poor continuity of primary care made conditions worse for patients dealing with chronic kidney disease (CKD), but they may benefit from stronger patient-physician relationships, according to a new study.

Appropriate prescriptions and interventions targeting specific comorbidities also could decrease patients’ reliance on acute care and emergency treatment.

Researchers noted CKD is a complex condition that often involves managing comorbidities such as hypertension, diabetes and cardiovascular disease. Acute care use is higher for CKD patients, so “effective primary care continuity might address health system burden and improve care experiences among this medically complex population,” said the study, “Determining the Association Between Continuity of Primary Care and Acute Care Use in Chronic Kidney Disease: A Retrospective Cohort Study,” published this month in the journal Annals of Family Medicine.

They measured relational continuity of primary care by the number of outpatient visits to a primary care clinician. “High continuity of care is patient centered and should be promoted in the CKD population across all levels of health care, given that it appears to mitigate acute care needs for potentially preventable conditions,” the study said.Analyzing 86,475 CKD patients in Alberta from a three-year period from 2011 to 2014, along with four outcome measures: all-cause hospitalizations; all-cause emergency department (ED) visits; CKD-related potentially preventable hospitalizations; and CKD-related potentially preventable ED visits.

Researchers found one in five “had poor continuity of primary care, and the rate of all-cause and potentially preventable acute care use significantly increased with poor continuity of care,” the study said. Poor continuity also resulted in sub-optimal prescribing of a recommended statin, according to a news release about the study.

“The present study suggests that if the association between continuity and CKD acute care use is causal, decreases in potentially preventable CKD-related acute care encounters might be realized via health care models and policies that strengthen patient-physician relationships and improve prescribing of guideline-recommended drugs for patients with less advanced stages of CKD,” the researchers said.