PMID- 32096082
OWN - NLM
STAT- MEDLINE
DCOM- 20210514
LR  - 20210514
IS  - 1525-1497 (Electronic)
IS  - 0884-8734 (Print)
IS  - 0884-8734 (Linking)
VI  - 35
IP  - 5
DP  - 2020 May
TI  - Effect Modification of Multimorbidity on the Association Between Regularity of 
      General Practitioner Contacts and Potentially Avoidable Hospitalisations.
PG  - 1504-1515
LID - 10.1007/s11606-020-05699-0 [doi]
AB  - BACKGROUND: Scheduled regular contact with the general practitioner (GP) may 
      lower the risk of potentially avoidable hospitalisations (PAHs). Despite the high 
      prevalence of multimorbidity, little is known about its effect on the 
      relationship between regularity of GP contact and PAHs. OBJECTIVE: To investigate 
      potential effect modification of multimorbidity on the relationship between 
      regularity of GP contact and probability of PAHs. DESIGN: A retrospective, 
      cross-sectional study. PARTICIPANTS: 229,964 individuals aged 45 years and older 
      from the 45 and Up Study in New South Wales, Australia, from 2009 to 2015. MAIN 
      MEASURES: The main exposure was regularity of GP contact (capturing dispersion of 
      GP contacts); the outcomes were PAHs evaluated by unplanned hospitalisations, 
      chronic ambulatory care sensitive condition (ACSC) hospitalisations and unplanned 
      chronic ACSC hospitalisations. Multivariable logistic regression models and 
      population attributable fractions (PAF) were conducted to identify effect 
      modification of multimorbidity, assessed by Rx-Risk comorbidity score. KEY 
      RESULTS: Compared with the lowest quintile of regularity, the highest quintile 
      had significantly lower predicted probability of unplanned admission (- 79.9 per 
      1000 people at risk, 95% confidence interval (CI) - 85.6; - 74.2), chronic ACSC 
      (- 6.07 per 1000 people at risk, 95%CI - 8.07; - 4.08) and unplanned chronic ACSC 
      hospitalisation (- 4.68 per 1000 people at risk, 95%CI - 6.11; - 3.26). Effect 
      modification of multimorbidity was observed. Specifically, the PAF among people 
      with no multimorbidity indicated that 31.7% (95%CI 28.7-34.4%) of unplanned, 
      36.4% (95%CI 25.1-45.9%) of chronic ACSC and 48.9% (95%CI 32.9-61.1%) of 
      unplanned chronic ACSC hospitalisation would be reduced by a shift to the highest 
      quintile of regularity. However, among people with 10+ morbidities, the 
      proportional reduction was only 5.2% (95%CI 3.8-6.5%), 9.0% (95%CI 0.5-16.8%) and 
      17.8% (95%CI 5.4-28.5%), respectively. CONCLUSIONS: Weakening of the association 
      between regularity and PAHs with increasing levels of multimorbidity suggests a 
      need to improve primary care support to prevent PAHs for patients with 
      multimorbidity.
FAU - Ha, Ninh Thi
AU  - Ha NT
AUID- ORCID: 0000-0002-2789-5604
AD  - Health Systems and Health Economics, School of Public Health, Curtin University, 
      Perth, Western Australia, Australia. thi.ha@curtin.edu.au.
FAU - Wright, Cameron
AU  - Wright C
AD  - Health Systems and Health Economics, School of Public Health, Curtin University, 
      Perth, Western Australia, Australia.
AD  - School of Medicine, College of Health & Medicine, Faculty of Health, University 
      of Tasmania, Hobart, Tasmania, Australia.
FAU - Youens, David
AU  - Youens D
AD  - Health Systems and Health Economics, School of Public Health, Curtin University, 
      Perth, Western Australia, Australia.
FAU - Preen, David B
AU  - Preen DB
AD  - Centre for Health Services Research, School of Population and Global Health, The 
      University of Western Australia, Crawley, WA, Australia.
FAU - Moorin, Rachael
AU  - Moorin R
AD  - Health Systems and Health Economics, School of Public Health, Curtin University, 
      Perth, Western Australia, Australia.
AD  - School of Population and Global Health, The University of Western Australia, 
      Crawley, WA, Australia.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20200224
PL  - United States
TA  - J Gen Intern Med
JT  - Journal of general internal medicine
JID - 8605834
SB  - IM
MH  - Australia
MH  - Cross-Sectional Studies
MH  - *General Practitioners
MH  - Hospitalization
MH  - Humans
MH  - Middle Aged
MH  - *Multimorbidity
MH  - New South Wales
MH  - Retrospective Studies
PMC - PMC7210343
OTO - NOTNLM
OT  - avoidable hospitalisation
OT  - multimorbidity
OT  - regularity of primary care
COIS- The authors declare that they do not have a conflict of interest.
EDAT- 2020/02/26 06:00
MHDA- 2021/05/15 06:00
PMCR- 2021/05/01
CRDT- 2020/02/26 06:00
PHST- 2019/07/10 00:00 [received]
PHST- 2020/02/03 00:00 [accepted]
PHST- 2019/12/18 00:00 [revised]
PHST- 2020/02/26 06:00 [pubmed]
PHST- 2021/05/15 06:00 [medline]
PHST- 2020/02/26 06:00 [entrez]
PHST- 2021/05/01 00:00 [pmc-release]
AID - 10.1007/s11606-020-05699-0 [pii]
AID - 5699 [pii]
AID - 10.1007/s11606-020-05699-0 [doi]
PST - ppublish
SO  - J Gen Intern Med. 2020 May;35(5):1504-1515. doi: 10.1007/s11606-020-05699-0. Epub 
      2020 Feb 24.