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Research

Factors associated with attendance at primary care appointments after discharge from hospital: a retrospective cohort study

Kenneth Lam, Howard B. Abrams, John Matelski and Karen Okrainec
December 03, 2018 6 (4) E587-E593; DOI: https://doi.org/10.9778/cmajo.20180069
Kenneth Lam
Department of Medicine (Lam, Abrams, Okrainec), University of Toronto; Division of General Internal Medicine (Abrams, Okrainec), University Health Network; Biostatistics Research Unit (Matelski), University Health Network, Toronto, Ont.
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Howard B. Abrams
Department of Medicine (Lam, Abrams, Okrainec), University of Toronto; Division of General Internal Medicine (Abrams, Okrainec), University Health Network; Biostatistics Research Unit (Matelski), University Health Network, Toronto, Ont.
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John Matelski
Department of Medicine (Lam, Abrams, Okrainec), University of Toronto; Division of General Internal Medicine (Abrams, Okrainec), University Health Network; Biostatistics Research Unit (Matelski), University Health Network, Toronto, Ont.
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Karen Okrainec
Department of Medicine (Lam, Abrams, Okrainec), University of Toronto; Division of General Internal Medicine (Abrams, Okrainec), University Health Network; Biostatistics Research Unit (Matelski), University Health Network, Toronto, Ont.
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    Figure 1:

    Flow of patients through the study.

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    Figure 2:

    Kaplan–Meier curves for time to readmission for patients by attendance at a primnary care appointment. Models were adjusted for age, sex, Charlson Comorbidity Index, length of stay, and visits to the emergency department in the previous 6 months. Error bars indicate 95% confidence intervals.

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    Table 1:

    Baseline characteristics of discharged medical patients categorized by attendance at primary care appointments

    CharacteristicAll patients
    n = 214
    Attendance at PCP appointment
    No
    n = 90 (42%)
    Yes
    n = 124 (58%)
    Unadjusted OR (95% CI)
    Age, yr, mean ± SD70 ± 1668 ± 1871 ± 151.01 (0.99–1.03)
    Male sex122 (57)47 (52)75 (60)1.40 (0.81–2.42)
    Discharge diagnosis
     CHF40 (19)20 (22)20 (16)0.67 (0.34–1.34)
     CAP18 (8.4)8 (8.9)10 (8.1)0.90 (0.34–2.38)
     COPD16 (7.5)4 (4.4)12 (9.7)2.30 (0.72–7.39)
    Charlson Comorbidity Index, mean ± SD2.6 ± 2.02.5 ± 2.02.7 ± 2.01.04 (0.91–1.19)
    Length of stay, d, mean ± SD (median)8.6 ± 9.4 (6)9.4 ± 9.6 (6)8.0 ± 9.2 (5)0.98 (0.96–1.01)
    ED visits in previous 6 mo, mean ± SD1.0 ± 1.91.3 ± 2.40.9 ± 1.40.89 (0.77–1.04)
    Cognitive impairment or psychiatric diagnosis92 (43)43 (48)49 (40)0.71 (0.41–1.24)
    Language barrier83 (39)37 (41)46 (37)0.84 (0.48–1.47)
    Social isolation24 (11)7 (7.8)17 (14)1.88 (0.75–4.75)
    Mobility impairment100 (47)46 (51)54 (44)0.74 (0.43–1.27)
    Presence of a home support worker134 (63)62 (69)72 (58)0.63 (0.35–1.11)
    Primary care appointment booked before discharge109 (51)36 (40)73 (59)2.15 (1.24–3.73)
    Received booking help from transitional care specialist105 (51)38 (42)68 (55)1.61 (0.93–2.78)
    Familiar primary care provider166 (78)62 (69)104 (84)2.35 (1.22–4.52)
    Requested a new primary care provider58 (27)25 (28)33 (27)0.94 (0.51–1.73)
    Specialist appointment booked before discharge61 (29)36 (40)25 (12)0.38 (0.21–0.70)
    Weekend discharge26 (12)10 (11)16 (13)1.19 (0.51–2.75)
    Provided no instructions regarding primary care follow-up42 (19)21 (23)21 (17)0.67 (0.34–1.32)
    Recommended primary care follow-up only111 (52)47 (52)64 (52)0.98 (0.57–1.68)
    Recommended primary care follow-up and provided time but no callback number41 (19)17 (19)24 (19)1.03 (0.52–2.06)
    Recommended primary care follow-up and provided callback number but no appointment time8 (3.7)4 (4.4)4 (3.2)0.72 (0.17–2.95)
    Recommended primary care follow-up and provided both callback number and time12 (5.6)1 (1.1)11 (8.8)8.66 (1.1–68.32)
    • Note: CAP = community acquired pneumonia, CHF = congestive heart failure, CI = confidence interval, COPD = chronic obstructive pulmonary disease, ED = emergency department, OR = odds ratio, PCP = primary care physician, SD = standard deviation.

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    Table 2:

    Factors associated with attendance at postdischarge primary care appointment after stepwise regression,* adjusted for age, sex and Charlson Comorbidity Index

    FactorAdjusted OR (95% CI)
    Age1.01 (0.98–1.03)
    Male sex1.20 (0.62–2.33)
    Charlson Comorbidity Index1.07 (0.91–1.26)
    Presence of a home support worker0.38 (0.17–0.80)
    Pimary care appointment booked before discharge2.14 (1.07–4.40)
    Familiar primary care provider5.43 (2.25–14.1)
    Specialist appointment booked before discharge0.37 (0.18–0.73)
    Discharge summary
     Recommended primary care follow-up only†1.00 (0.44–2.25)
     Recommended primary care follow-up and provided time but no callback number†0.79 (0.27–2.28)
     Recommended primary care follow-up and provided callback number but no appointment time†0.97 (0.17–5.53)
     Recommended primary care follow-up and provided both callback number and time†15.3 (2.09–326)
    • Note: CI = confidence interval, OR = odds ratio.

    • ↵* Mixed stepwise regression based on Akaike information criterion.

    • ↵† Reference group is discharge summary provided no instructions regarding primary care follow-up.

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    Table 3:

    Results of Cox proportional hazards model for readmission for patients by attendance at primary care follow-up

    FactorHR (95% CI)p value
    Attended primary care appointment0.66 (0.40–1.09)0.1
    Age1.00 (0.76–1.31)0.96
    Male sex0.92 (0.54–1.56)0.8
    Length of stay1.04 (0.83–1.31)0.7
    Charlson Comorbidity Index1.01 (0.79–1.30)0.9
    ED visits in past 6 mo1.30 (1.08–1.56)0.005
    • Note: CI = confidence interval, ED = emergency department, HR = hazard ratio.

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CMAJ Open: 6 (4)
Vol. 6, Issue 4
1 Oct 2018
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Factors associated with attendance at primary care appointments after discharge from hospital: a retrospective cohort study
Kenneth Lam, Howard B. Abrams, John Matelski, Karen Okrainec
Oct 2018, 6 (4) E587-E593; DOI: 10.9778/cmajo.20180069

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Factors associated with attendance at primary care appointments after discharge from hospital: a retrospective cohort study
Kenneth Lam, Howard B. Abrams, John Matelski, Karen Okrainec
Oct 2018, 6 (4) E587-E593; DOI: 10.9778/cmajo.20180069
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