Длительное наблюдение у одного врача снижает количество экстренных госпитализаций и экономит средства

A retrospective cohort study published in Annals of Family Medicine in June 2026 found that long-term continuity of care in primary care was associated with fewer emergency hospital admissions and lower healthcare costs. The study, led by Otto Maarsingh, MD, PhD, from the Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands, and colleagues, analyzed clinical data from more than 100,000 adults treated at 48 Dutch primary care practices between 2013 and 2018. The researchers linked these data with national hospitalization records from 2019. To determine which aspects of continuity were associated with better outcomes, the researchers examined two independent measures: the duration of the patient’s relationship with the practice and the concentration of visits with the same physician, measured using the Herfindahl-Hirschman index. The results suggested that the duration of care may matter the most. Patients who had been registered with the same practice for 15-20 years had 9%-21% lower odds of emergency hospital admission than those who had been registered for less than 5 years. In contrast, a greater concentration of visits with the same physician was not significantly associated with emergency hospital admissions. The economic findings were also substantial. Remaining with the same practice for more than 5 years was associated with lower hospital costs across age groups, with the largest reduction, 39.7%, among patients who had been registered with the same practice for 10-15 years. A greater concentration of visits with the same physician was associated with an additional 6%-7% reduction in hospital costs. Evidence and Nuance Speaking on behalf of the Spanish Society of General and Family Physicians, spokesperson Lorenzo Armenteros del Olmo, MD, described the study as methodologically strong: “It is a solid and pioneering study.” He highlighted its methodology, noting that it is the first study to combine two measures of continuity — the duration of the patient-physician relationship and the concentration of visits with the same physician — with two outcomes, emergency admissions and costs, within the same analysis. With more than 100,000 patients and outcomes obtained from national administrative records, he said that the data were highly reliable. However, Armenteros emphasized that the study showed an observational association rather than causation. He noted that the association did not increase linearly with the duration of registration. Instead, the largest reduction in emergency admissions was observed among patients who had been registered with the practice for 15-20 years. In his view, this may indicate that the group with the longest duration of care included older patients with multiple comorbidities and that statistical adjustment may not have fully accounted for differences in disease severity. He also explained why longer continuity of care was linked to lower hospital costs, even when emergency admissions still occurred. “Heart attacks, strokes, and sepsis are largely unpredictable and difficult to prevent through continuity of care.” However, there are two important points. First, a longer continuity of care was associated with fewer emergency admissions and lower costs. Maintaining a relationship with patients over several years can help clinicians recognize deterioration earlier and intervene before a condition leads to emergency admission. Second, the apparent lack of an association between visit frequency and emergency admissions may be misleading. Patients with greater healthcare needs are more likely to have frequent visits, which can make any protective effect of regular contact harder to detect. The key point, therefore, is that the benefit comes from maintaining a relationship with patients over time, rather than simply increasing the number of visits. Implications for Care Beyond the numbers, the study suggests that continuity in primary care may support more informed clinical decision-making. Knowing a patient’s medical history over many years may help physicians assess changes in health and avoid unnecessary emergency referrals. The findings emphasized the stability of the frequency of individual consultations. The potential benefit appears to be associated with maintaining a relationship over time rather than simply increasing the number of visits. The study also highlighted the potential economic value of continuity. Maintaining a stable patient-physician relationship may therefore be more than an organizational preference or a measure of patient satisfaction. It may also have implications for healthcare costs and pressure on the public healthcare system. When applying these findings to Spain’s National Health System (SNS), Armenteros noted the main implication is relevant, but differences in how healthcare is organized need to be considered. “The underlying effect is transferable, but its extent cannot be assumed to be the same without considering these differences.” The Dutch and Spanish healthcare systems share some key features: The family physician serves as a gateway to the healthcare system, and patients are registered with a primary care practice. Armenteros noted that Spain’s SNS may provide even stronger personal continuity because patients are formally assigned to a specific physician rather than simply to a primary care practice. However, in practice, maintaining this continuity has become more difficult because of increasing workloads, temporary staffing, large patient lists, and challenges in filling some positions. Finally, Armenteros warned that the growing use of telephone consultations could contribute to the depersonalization of care. Remote consultations lack a physical examination, nonverbal communication, and incidental findings that can help physicians identify deterioration. “Telemedicine is not neutral with regard to continuity,” he said. “If the teleconsultation is with your own doctor, it strengthens the relationship. If it is with whichever doctor at the health center happens to be available, it can weaken that relationship and undermine the very factor that this study identifies as protective. The personalized care model, with a doctor who knows and treats the patient over time, matters more than the technology used to communicate,” he said. This article was translated from El Médico Interactivo on Univadis, part of the Medscape Professional Network.