Continuity of care in a pandemic: an observational study in GP-centred healthcare in Germany.

Abstract

Background: Continuity of care (COC) refers to the sustained quality of healthcare over time and is a central element of effective general practice. High levels of COC have been associated with improved health outcomes, including reduced risks of hospitalisation. Previous research demonstrated that participation in Germany's "general practitioner-centred healthcare" (GPCHC) programme, designed to strengthen general practice care, led to higher COC. Furthermore, higher COC was independently linked to decreased risks of hospitalisations, including rehospitalisations and avoidable admissions. This study aimed to investigate whether the benefits of COC for GPCHC patients persisted in 2020, the first year of the COVID-19 pandemic, compared with 2019, the year preceding the pandemic.

Methods: An observational study was conducted in Germany using data from a health insurance database. The study included two patient cohorts: those enrolled in the GPCHC programme (n=1 049 910) and those not enrolled in GPCHC (n=537 759) for both 2019 and 2020. The analysis compared three measures of COC-Usual Provider Index, Herfindahl Index and Sequential Continuity Index-adjusted for patient characteristics. Longitudinal multivariable regression models were employed to evaluate differences between the cohorts and assess the impact of the COVID-19 pandemic on COC outcomes.

Results: For GPCHC patients, COC in general practice was relevantly and significantly higher with respect to the three COC measures in 2019. We could observe the same advantage for GPCHC patients in 2020. Interestingly, for the SCI index, indicating the fraction of sequential encounter pairs at which the same provider is seen, we could observe that COC was even more advantageous for GPCHC patients in 2020 in comparison to 2019. Finally, we could observe that higher COC in 2019 was independently associated with decreased healthcare utilisation of the inpatient care sector in 2020.

Conclusions: In a pandemic period in which healthcare is faced with new challenges, both for patients and healthcare providers, GPCHC was still associated with higher COC. The GPCHC programme and its contents are obviously better up to the requirements of the COC even in such a situation of pandemic-induced discontinuity.