Clinic continuity was associated with lower acute care costs, most in complex patients

Design

Retrospective population-based cross-sectional study, 3 years

Population

About 70,000 matched adults with chronic disease, Alberta

Primary outcome

Health service utilisation costs by clinic continuity level

Effect

High continuity associated with lower acute costs; projected up to £898m over 3 years

A retrospective population study in the British Journal of General Practice (21 September) examined about 70,000 matched patients with chronic disease, drawn from 500,000 in Alberta, Canada, over three years. It measured how consistently each patient was seen in the same clinic, using an adapted Usual Provider of Care index.

High clinic continuity (80–100% of visits at the usual clinic) was associated with lower acute care costs at every level of complexity. The authors model that moving all 195,000 patients with lower continuity to high continuity could theoretically save more than £898 million over three years, with the largest per-patient gains among the most medically complex.

The savings figure is a projection from associations, not a measured effect. But it adds to a consistent body of evidence that continuity is one of the few things in primary care that reliably tracks with fewer admissions.

• Book follow-up for complex patients with the same clinician or team where possible
• Flag your highest-complexity patients for protected continuity
• Use team-based models that keep the patient within one small team
• Record the named clinician in the notes so others can route follow-up

Why it matters

It puts a system-level value on something family physicians control day to day: who sees the patient next.

Don't overread it

The savings are modelled from an association, not measured after an intervention.

The statistics, in plain English

The £898 million is an extrapolation that assumes the cost difference is caused by continuity. In a cross-sectional design, sicker or less engaged patients may both move between clinics more and cost more, which would exaggerate the effect.

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