Elderly patients who are hospitalized are much less likely to be seen by their primary care physician then they were a decade ago, raising concern about the increasing lack of continuity of care. The study by the researchers at the University of Texas Medical Branch at Galveston According to the study finds that in 1996, 50.5 percent of hospitalized Medicare patients were seen by at least one physician who had seen them in an outpatient setting at least once during the previous year. But by 2006, that percentage had declined to 39.8 percent, the study finds.

 

What’s more, 44.3 percent of patients who were hospitalized in 1996 were visited at least once by a primary care physician who had seen them prior to hospitalization, according to the study, which appears in the Journal of the American Medical Association. By 2006, this percentage had declined to 31.9 percent, finds the study, which examined data on more than 3 million hospital admissions of people over 66 years old.

 

The researchers say part of the reduction in continuity of care results from the increasing use of hospitalists, physicians who specialize in the care of hospitalized patients. “Approximately one-third of the decrease in continuity [of care] between 1996 and 2006 was associated with growth in hospitalist activity,” according to the study. The study says continuity of care consists of three dimensions: Continuity in information, continuity in management, and continuity in the patient-physician relationship.

 

In addition to the increased use of hospitalists, the study says that Medicare payment formulas discourage primary care physicians from continuing to care for their patients when a hospitalist becomes involved. Direct communication between primary care physicians and hospitalists occurred less than 20 percent of the time, the study says.

 

The researchers say the effect of reduced continuity of care on patient outcomes should be studied further as should whether interventions could be developed to minimize any detrimental effects.