Continuity of primary care and end-of-life care costs in dementia: a retrospective cohort study.

Abstract

End-of-life dementia care costs are expected to rise as populations age. Higher continuity of care with GPs is associated with reduced hospital admissions at the end of life, but the impact on costs is not known. To explore the association of continuity of primary care on hospital and general practice costs in the last year of life among people with dementia. A retrospective cohort study using a primary care dataset linked with national hospital and mortality records. Adults (aged >18 years) who died in England between 2009 and 2018 with a diagnosis of dementia were included. The Continuity of Care Index (COCI) of GP contacts in the last year of life was calculated, which measures patterns of care across GPs. Hospital and general practice costs were calculated using average national tariffs. Costs were modelled using a multivariable generalised linear model, estimating the average marginal effect of perfect continuity over non-continuity of care. In total, 32 799 people were included. The mean age at death was 86.60 years (standard deviation [SD] 8.04 years), 64.2% (<i>n</i> = 21 057) were female, and 56.6% (<i>n</i> = 18 556) lived in care homes before death. The average COCI score was 0.38 (SD 0.25). People with perfect continuity had on average £2097 (95% confidence interval = 1319 to 2875) lower total costs in the last year than those with non-continuity of care. Continuity of care with GPs is associated with lower total costs and might contribute to reduce hospital admissions and costs among people with dementia in their last year of life.