How many primary care doctors would you say you’ve seen in your lifetime? If you answered “not a lot,” that’s a good thing, especially if you or someone you know suffers from dementia or other health conditions.
New research by the University of Exeter – published in the British Journal of General Practice this week – found that people (including patients with dementia) consistently seen by the same general practitioner (GP) – typically referred to as a primary care physician in the U.S. – improved their quality of care and lowered their risk of emergency admissions to the hospital.
Researchers analyzed more than 9,000 patient records of people diagnosed with dementia. They also found those who were consistently seen by the same GP over one year were given fewer medications and were less likely to be given medications that could have caused problems like loss of bladder control, drowsiness and falls.
“Dementia is very common in elderly patients; there’s about 900,000 in the UK and about 57 million worldwide,” João Delgado, PhD, lead researcher and research fellow at the University of Exeter Medical School, told Seasons. “There is no cure for dementia, so in the absence of a cure, quality treatment is the only thing we can do for that.”
What else you need to know about the study
Researchers studied 9,324 patients aged 65 and older in England who were diagnosed with dementia before the start of the study date. According to Delgado, 92% of the patients had dementia and one additional medical condition, and about 56% had three or more additional comorbidities.
Participants were analyzed for almost a year, and during follow-ups, researchers found those who saw the same GP over time:
- Reduced the risk of developing delirium, a disturbed state of mind most commonly triggered by dementia, by nearly 35%
- Reduced their risk of incontinence by nearly 58%
- Were 10% less likely to have an emergency hospitalization
“When you try to treat two conditions or even three at the same time, treating those things becomes complex,” Delgado said. “Certain medications can interact, and when they do, the benefits of the medication can be reduced, especially when you have medication that shouldn’t be mixed together.”
Most importantly, seeing the same physician can lead to a strong and trusting relationship between the provider and patient.
“With consistent care, not only does the doctor become more aware of your needs as a patient, but they will know your medical history, which can lead to you becoming more open to trusting your doctor’s advice,” Delgado said.
Sir Denis Pereira Gray, co-author and GP researcher at St. Leonard’s Medical Practice Exeter, told Seasons that beyond the findings of the study, there are other positive benefits of consistent care, including greater satisfaction by patients, higher patient adherence to medical advice given by doctors, more consistency in taking prescribed medications, and the development of greater trust in the practitioner.
He also said consistent care can lead to “lower use of emergency departments, lower admissions to the hospital, a decrease in overall costs to the health care system, and lower death rates.”
Importance of consistent care in other settings
Seasons asked the researchers of the study if the findings apply to other settings such as long-term care and assisted living facilities. While the authors did not specifically study that, consistent and high-quality care in those settings is just as important, according to Delgado.
“In long-term care settings, a contact point that coordinates that care or someone who knows that patient would be just as important and beneficial,” he said.
Other studies support the idea that having the same caregiver or nurse assigned to a resident often boosts the overall quality of care and quality of life for residents.
How this applies to care in the United States
Because the study was conducted in the United Kingdom, the authors highlight there could be differences in the type and quality of care received in other countries.
Delgado describes that, in the UK, when people are seeking care, they typically register for a GP practice. However, if that provider is not available at a given moment, the patient will see a different doctor each time, forcing health care professionals to relearn medical history for an existing or even new condition.
“If you have an issue and your GP isn’t available, you can wait or see someone else who’s available before that,” Delgado said. “If care isn’t planned in advance, then you can possibly not see the same GP frequently, and depending on how understaffed, it can be more or less frequent.”
He adds that in other countries, including the U.S., people have a choice to choose the doctor they want to see based on medical and health insurance plans.
However, Jordan Grumet, MD, a primary care doctor in Illinois, told Seasons that affordable health insurance plans might not always be available for everyone in the U.S.
“There are cost-of-care barriers that fragment our care,” he said. “Some patients are paying out-of-pocket, they’re paying deductibles at the beginning of the year and sometimes don’t meet their deductible, so they may not be as likely to go and see their primary care doctor.”
The peer-reviewed journal Health Affairs reports substantial health disparities and gaps when it comes to care in the United States. Some factors include race, gender, education, ZIP code, language, income and social class. With some of these factors in mind, Grumet said this can potentially lead to overutilization of care, prescriptions of unnecessary or harmful medications, and lack of conversations when it comes to end-of-life care.
“When care is fragmented, we don’t have those conversations about end-of-life care because you don’t have the relationship with your primary care provider,” he said. “Therefore, you’re going to have a high cost of care, more medicine and tests—but poorer outcomes.”
To close some of these gaps, he said investing in the primary care health system is essential:
“Reform payments to primary care doctors so they can afford to have fewer patients. When you have one doctor with 5,000 patients, it’s going to be hard to pay a lot of attention to them.”
Opening up the system and allowing nurse practitioners and other trained medical staff to assist with care, he said, can take some load off the primary care doctor community.
The researchers of the study note continuity of care has been declining progressively in the UK in the last two decades, with staffing shortages being a key factor.
“An understaffed GP service needs to meet an increasing demand due to the increased number of patients,” Delgado said. “This complicates scheduling and physicians’ ability to coordinate care, and as a result continuity of care declines.”
In terms of solutions, Delgado believes prioritization for those patients who may benefit more from seeing the same physicians consistently should be considered.