Breaking the Traditional Bond: Few Patients Retain Their Family Practitioner After LTC Admission
The relationship between a patient and a family practitioner is a special bond that many people find to be indispensable. In fact, “relational continuity,” the therapeutic relationship between a patient and one or more providers spanning various health care events over time, is a key aspect of family practice. Many older adults deeply value this relationship. However, an article in the December issue of JAMDA documents that out of 50,089 long-term care (LTC) facility residents studied, only 12.1% retained their family physician after admission, for a variety of reasons.
In Do Patients Retain Their Family Physician After Long-Term Care Entry? A Retrospective Cohort Study, the authors found that resident factors associated with reduced odds of retention included physical impairment, cognitive impairment, and a dementia diagnosis. They said that this suggests physicians “may preferentially follow-up with patients who are less complex; and cognitive and functional impairment are hallmarks of complexity.”
Physician factors related with lower retention included a greater distance between the LTC facility and the physician’s clinic. The relationship also was less likely to continue, the authors said, if the physician was female, an international medical graduate, or someone who practices in a capitation-based Family Health Organization.
At the same time, the patient-practitioner relationship was more likely to continue if the resident resided in a rural LTC facility, had a rural family physician, or had a family physician who had billed LTC fee codes in the past year.
The authors concluded that the low percentage of patients retaining their family practitioner after LTC facility admission underscores “this health care transition as a breakdown point in relational continuity.” This issue is worth further study, they suggested, as this “disruption may exacerbate health problems and further burden families and the health care system regardless of the quality of care provided in the LTC facility.” The authors added, “Understanding relational continuity in LTC is a critical first step toward informing and improving the care of this increasingly large and vulnerable population.”
This study was conducted by researchers at Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Bruyere Research Institute, Ottawa, Ontario, Canada; ICES Ottawa, Ottawa, Ontario, Canada; ICES McMaster, Hamilton, Ontario, Canada; Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada; and St. Patrick’s Home of Ottawa, Ottawa, Ontario, Canada.
JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit www.jamda.com for more information.
About AMDA – The Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit www.paltc.org for more information.