Study shows ‘positive impact’ of keeping usual GP in aged care

Only 17% of aged care residents keep their usual GP after a move to a long-term care facility, but they are more likely to stay in better health, new Australian research has found.
                                                                                     
The retrospective study, carried out by the Registry of Senior Australians (ROSA) Research Group, looked at the health outcomes of 331,220 older, long-term care residents at almost 3000 facilities across Australia from 1 January 2013 to 31 December 2019.
 
The results, now published in the Age and Ageing journal, found those who kept their usual GP had an 8% lower risk of emergency department presentations and a 6% lower risk of unplanned hospitalisations more broadly.
 
Meanwhile, the likelihood of dementia-related hospitalisations reduced by as much as 21%.
 
More than half of the cohort, which had a median age of 83.8 years, had dementia.
 
As well as GP continuity of care, the research found proactive preventive care involving allied health professionals, pharmacists and nurse practitioners all helped deliver better outcomes.
 
Of the 233,701 residents in long-term care for at least six months, 17.3% saw their usual GP, 71.4% had new GPs, and 11.3% saw a known GP.
 
For Dr Anthony Marinucci, Chair of RACGP Specific Interests Aged Care, this is one of the most striking findings of the study.
 
‘Keeping your community GP doesn’t seem to be the default in the system,’ he told newsGP.
 
‘That’s an interesting, very important diagnostic point. We know that continuity is good, but we also know that it’s very low.’
 
Dr Marinucci said that with many aged care residents going into facilities away from where they previously lived, as well as an ageing GP workforce, it is not realistic to aim for everybody to retain their community doctor.
 
‘My interpretation is that continuity doesn’t necessarily have to mean the same GP or the same person forever, because there’s obviously constraints around that,’ he said.
 
‘How else can we measure and monitor that continuity? If it’s not possible by the same person, what other markers are there?
 
‘Are we doing good clinical handovers? Is there a structured approach to someone that goes from being in the community into aged care? I know myself with my personal practice, it is often very hard to get information.’
 
ROSA researchers say the results illustrate the importance of increased funding for continuity of care.
 
‘Identifying continuity of care as such a strong contributor to a lower risk of poor outcomes provides a strong impetus for more investment in ensuring ongoing support from and access to usual GPs and improved health care integration in [long-term care] facilities,’ they wrote.
 
ROSA Principal Investigator, Professor Gill Caughey, said the results highlight the impact of care involving preventive health checks, management plans and allied health services compared with reactive care.
 
‘Podiatrists, optometrists, pharmacists and nurse practitioners all play a critical role,’ she said.
 
‘Together, they help residents stay healthier for longer and reduce unnecessary pressure on hospitals.
 
‘We need to set up our system so that residents don’t lose access to trusted GPs when they move into a facility, and other health care professionals are part of the team caring for those people from the start.’
 
The authors also noted the recent Federal Government introduction of GP Aged Care Incentives, but said their impact is yet to be examined.
 
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