Table 1.
Characteristics of included studies
| Author, Year | Study design | Data period | Average Follow up | Country | Setting | Sample characteristics N Mean age (years) % Female Comorbidities Cognitive impairment |
Continuity primary care approach & measure | Comparison | Outcome a |
|---|---|---|---|---|---|---|---|---|---|
| McGregor, 2018 [55] | Retrospective cohort study | July 2008—June 2013 | NR | Canada | Home Care |
N: 246 Age: 85 Female: 65% Impairments: ADL: NR Cognitive: NR |
Home Based Primary Care (HBPC) Program: Family physicians and NPs home visits with allied health support. A/H emergency care No CoC measure | 21 months prior to HBPC, before-after b |
Hospitalisation ED presentation |
| Jones, 2020 [56] | Retrospective cohort study | Oct 2014—Sept 2016 | 6 months | Canada | Home Care |
N: 178,686 Age: 82 Female: 61% Comorbidities (median (Q1, Q3): 3 (2,4) Impairment: ADL 41% Cognitive 59% |
Continuity of care with same primary care family physician as per Bice Boxerman index (BBI), high ≥ 66.th percentile (median BBI 0.88), medium 33–66 percentile (median BBI 0.73) | Low continuity ≤ 33.rd percentile (median BBI 0.54) |
Hospitalisation ED presentation |
| Bynum, 2011 [54] | Retrospective cohort study | 1997–2006 | 1–5 years | United States | 4 Continuing Care Retirement Communities |
N: 2468 Age: 85 Female: 67% Cognitive: NR |
On-site 3 primary care physicians and 2 part-time NPs providing all clinical care including A/H coverage on rotation. Average number of primary physicians seen | 3 sites limited on-site physician hours (1.5 – 2 days). A/H coverage by physician’s practice |
Hospitalisation ED presentation Primary care visits Mortality |
| Susman, 1989 [57] | Cross-sectional | June–Dec 1983 | 10.8 days | United States | Nursing home (1 site), residents transferred to hospital |
N = 335 Age (mean): 82 Female: 72% Impairments: ADL: Y (%NR) Cognitive: NR |
Continuity of care from primary physician rendering majority of routine care, while in hospital. Number of visits (1,2, ≥ 3) | Not visited by primary care physician in hospital (0 visits) |
Length of stay Mortality |
| Haines, 2020 [53] | Stepped wedge, cluster RCT | Dec 2012—Sept 2014 | 54 weeks pre-and post-trial | Australia | 15 private residential aged care facilities |
N = NR Sites = 15 homes, mean 98 beds (SD 31) Age = NR Female = NR Impairments ADL: NR Cognitive: = NR |
Standard practice: residents seen by external GPs not linked to facility staff (ideally community GP). RN undertake medication rounds and complex procedures where EN has most responsibility. No CoC measure | In-house GP with clinical manager. RN/EN team leader for PCAs who dispense medications instead of RN |
Hospitalisation ED presentation A/H primary care visits. Polypharmacy Mortality Falls Carer satisfaction |
Abbreviations; A/H after hours, ADL activities of daily living, BBI Bice-Boxerman Index, CoC continuity of care, EN enrolled nurse, GP general practitioners, HBPC Home Based Primary Care, NP nurse practitioners, PCA Personal Care Attendants, RN registered nurse, SD standard deviation Y = reported presence of ADL and cognitive impairment
a Outcomes other than hospitalisation or ED presentation are reported in supplementary file 2 and mentioned briefly in results text
b Comparison of HBPC vs alternate home care program not eligible for inclusion in this review