Relationship between longitudinal continuity of primary care and likelihood of death: analysis of national insurance data

PLoS One. 2013 Aug 22;8(8):e71669. doi: 10.1371/journal.pone.0071669. eCollection 2013.


Background: Continuity of care (COC) is a widely accepted core principle of primary care and has been associated with patient satisfaction, healthcare utilization and mortality in many, albeit small, studies.

Objective: To assess the relationship between longitudinal continuity with a primary care physician (PCP) and likelihood of death in the French general population.

Design: Observational study based on reimbursement claims from the French national health insurance (NHI) database for salaried workers (2007-2010).

Setting: Primary care.

Patients: We extracted data on the number and pattern of visits made to a PCP and excluded all patients who did not visit a PCP at least twice within 6 months. We recorded age, gender, comorbidities, social status, and deaths.

Main outcome measures: The primary endpoint was death by all causes. We measured longitudinal continuity of care (COC) with a PCP twice a year between 2007 and 2010, using the COC index developed by Bice and Boxerman. We introduced the COC index as time-dependent variables in a survival analysis after adjustment for age, gender and stratifying on comorbidities and social status.

Results: A total of 325 742 patients were included in the analysis. The average COC index ranged from 0.74 (SD: 0.35) to 0.76 (0.35) (where 1.0 is perfect continuity). Likelihood of death was lower in patients with higher continuity (hazard ratio for an increase in 0.1 of continuity, adjusted for age, sex, and stratified on comorbidities and social status: 0.96 [0.95-0.96]).

Conclusion: Higher longitudinal continuity was associated with a reduced likelihood of death.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Child, Preschool
  • Continuity of Patient Care / statistics & numerical data*
  • Female
  • France
  • Humans
  • Infant
  • Infant, Newborn
  • Insurance, Health, Reimbursement / statistics & numerical data
  • Male
  • Middle Aged
  • National Health Programs / statistics & numerical data*
  • Office Visits / statistics & numerical data
  • Physician-Patient Relations*
  • Primary Health Care / methods
  • Primary Health Care / statistics & numerical data
  • Proportional Hazards Models
  • Survival Analysis
  • Time Factors
  • Young Adult

Grants and funding

The authors have no support or funding to report.