Table 3. Adjusted cause-specific hazard ratios of time-dependent continuity of care calculated with all outpatient family physician and specialist visits (COC using ≥ 2 visits annually).
| Condition 1 (n = 166,665) to Condition 2 | Condition 2 (n = 119,520) to Condition 3 | Condition 3 (n = 68,021) to Condition 4 | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Characteristic | CHR | 95% CI | p-value | CHR | 95% CI | p-value | CHR | 95% CI | p-value | |
| Continuity of care‡ | ||||||||||
| Low (≤ 0.71) | Reference | - | - | Reference | - | - | Reference | - | - | |
| High (> 0.71) | 0.91 | (0.90 to 0.93) | <0.0001 | 0.91 | (0.89 to 0.93) | <0.0001 | 0.93 | (0.91 to 0.96) | <0.0001 | |
| <2 visits | 0.75 | (0.74 to 0.76) | <0.0001 | 0.67 | (0.65 to 0.69) | <0.0001 | 0.68 | (0.64 to 0.71) | <0.0001 | |
| Age (years) | ||||||||||
| 18 to 24 | Reference | - | - | Reference | - | - | Reference | - | - | |
| 25 to 29 | 1.09 | (1.05 to 1.13) | <0.0001 | 1.22 | (1.10 to 1.36) | <0.0001 | 1.49 | (1.07 to 2.07) | 0.017 | |
| 30 to 34 | 1.24 | (1.20 to 1.30) | <0.0001 | 1.34 | (1.21 to 1.50) | <0.0001 | 1.54 | (1.12 to 2.11) | <0.0001 | |
| 35 to 39 | 1.44 | (1.39 to 1.50) | <0.0001 | 1.61 | (1.46 to 1.78) | <0.0001 | 1.98 | (1.45 to 2.71) | <0.0001 | |
| 40 to 44 | 1.62 | (1.57 to 1.68) | <0.0001 | 1.79 | (1.62 to 1.97) | <0.0001 | 2.46 | (1.80 to 3.36) | <0.0001 | |
| 45 to 49 | 1.92 | (1.86 to 1.99) | <0.0001 | 2.18 | (1.98 to 2.41) | <0.0001 | 2.78 | (2.04 to 3.79) | <0.0001 | |
| 50 to 54 | 2.21 | (2.13 to 2.29) | <0.0001 | 2.46 | (2.23 to 2.71) | <0.0001 | 3.18 | (2.34 to 4.34) | <0.0001 | |
| 55 to 59 | 2.42 | (2.34 to 2.51) | <0.0001 | 2.69 | (2.44 to 2.97) | <0.0001 | 3.48 | (2.56 to 4.74) | <0.0001 | |
| 60 to 64 | 2.73 | (2.63 to 2.83) | <0.0001 | 3.02 | (2.74 to 3.33) | <0.0001 | 3.86 | (2.84 to 5.26) | <0.0001 | |
| 65 to 69 | 3.03 | (2.91 to 3.14) | <0.0001 | 3.26 | (2.95 to 3.60) | <0.0001 | 4.25 | (3.12 to 5.79) | <0.0001 | |
| 70 to 74 | 3.22 | (3.10 to 3.35) | <0.0001 | 3.51 | (3.17 to 3.87) | <0.0001 | 4.73 | (3.47 to 6.44) | <0.0001 | |
| 75 to 79 | 3.54 | (3.40 to 3.70) | <0.0001 | 3.90 | (3.52 to 4.31) | <0.0001 | 5.27 | (3.86 to 7.18) | <0.0001 | |
| ≥ 80 | 3.80 | (3.65 to 4.00) | <0.0001 | 4.43 | (4.01 to 4.90) | <0.0001 | 6.27 | (4.61 to 8.54) | <0.0001 | |
| Sex | ||||||||||
| Male | Reference | - | - | Reference | - | - | Reference | - | - | |
| Female | 1.01 | (1.00 to 1.02) | 0.058 | 0.97 | (0.95 to 0.99) | 0.0006 | 0.90 | (0.88 to 0.93) | <0.0001 | |
| Residence | ||||||||||
| Rural | Reference | - | - | Reference | - | - | Reference | - | - | |
| Urban | 1.04 | (1.02 to 1.06) | <0.0001 | 1.02 | (1.00 to 1.05) | 0.11 | 0.99 | (0.95 to 1.03) | 0.47 | |
| Neighborhood income quintile | ||||||||||
| Quintile 1 (lowest income) | Reference | - | - | Reference | - | - | Reference | - | - | |
| Quintile 2 | 0.96 | (0.95 to 0.98) | <0.0001 | 0.95 | (0.92 to 0.98) | 0.0002 | 0.95 | (0.92 to 0.99) | 0.019 | |
| Quintile 3 | 0.94 | (0.92 to 0.95) | <0.0001 | 0.94 | (0.91 to 0.96) | <0.0001 | 0.94 | (0.90 to 0.98) | 0.0016 | |
| Quintile 4 | 0.92 | (0.90 to 0.94) | <0.0001 | 0.93 | (0.90 to 0.95) | <0.0001 | 0.94 | (0.90 to 0.98) | 0.0021 | |
| Quintile 5 (highest income) | 0.91 | (0.89 to 0.92) | <0.0001 | 0.90 | (0.87 to 0.92) | <0.0001 | 0.91 | (0.87 to 0.95) | <0.0001 | |
| Primary care enrolment model | ||||||||||
| Not-Enrolled | Reference | - | - | Reference | - | - | Reference | - | - | |
| Family Health Group | 1.11 | (1.09 to 1.14) | 0.63 | 1.01 | (0.98 to 1.03) | 0.54 | 1.03 | (0.99 to 1.06) | 0.15 | |
| Family Health Network or Organization | 1.04 | (1.02 to 1.07) | <0.0001 | 0.94 | (0.91 to 0.97) | <0.0001 | 0.96 | (0.92 to 1.01) | 0.09 | |
| Family Health Team | 1.02 | (0.99 to 1.05) | <0.0001 | 0.93 | (0.90 to 0.96) | <0.0001 | 0.93 | (0.89 to 0.97) | 0.0019 | |
| Other† | 1.13 | (1.08 to 1.18) | 0.27 | 1.03 | (0.98 to 1.08) | 0.24 | 1.04 | (0.97 to 1.11) | 0.26 | |
| Outpatient general practice visits | 1.13 | (1.11 to 1.12) | <0.0001 | 1.11 | (1.11 to 1.12) | <0.0001 | 1.09 | (1.08 to 1.09) | <0.0001 | |
| Outpatient specialist visits | 1.13 | (1.10 to 1.17) | <0.0001 | 1.09 | (1.06 to 1.12) | <0.0001 | 1.12 | (1.08 to 1.16) | <0.0001 | |
Abbreviations: CI = Confidence Interval; CHR = Cause-Specific Hazard Ratio.
Note: The relationship between continuity and a) Time in days until the diagnosis of the 2nd condition among those with at least 1 condition (n = 166,665), b) Time in days until the diagnosis of the 3rd condition among those with at least 2 conditions (n = 119,520), and c) Time in days until the diagnosis of the 4th condition among those with at least 3 conditions (n = 68,021) was estimated with multivariable cause-specific hazards regression models. The effect estimate of continuity was adjusted for age, sex, neighborhood income, primary care enrolment model, number of physician visits (outpatient general practice, outpatient specialist), and place of residence simultaneously.
‡Continuity of care was measured using the Bice-Boxerman Index and categorized as high versus low continuity at the median among all patients at index. All visits to family physicians and specialists in outpatient settings (office, home, long-term care, emergency department, telephone, ‘undefined’) in the previous year were counted in the calculation of continuity.
†Comprehensive Care Model, Community Sponsored Agreement, Community Health Group, Group Health Center, Health Services Organization, Primary Care Network, Rural and Northern Group, South Eastern Area Medical Organization, and St. Joseph’s Health Centre.