Continuity of Primary Care and end-of-life care costs in dementia: a cohort study

Javiera Leniz; Peter May; Martin Gullifiord; Katherine E. Sleeman

doi:10.3399/BJGP.2025.0218

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Continuity of care in primary care: is it time to demand it?
Manuel Martinez-Selles

Published on: 12 November 2025

Published on: (12 November 2025)
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Continuity of care in primary care: is it time to demand it?
Manuel Martinez-Selles, Cardiologist. President Madrid College of Physicians, Hospital Universitario Gregorio Marañón
We read with great interest the article by Leniz et al.¹ The authors show how primary care continuity (PCC) is associated to lower total costs and might contribute to reduce hospital admissions and costs among people with dementia in their last year of life. This important study adds to previous data supporting the benefit of PCC. We already have evidence showing that PCC is associated with increased survival.^2,3 Furthermore, PCC reduces hospitalizations,^4,5 emergency department visits,⁵ and improves cancer screening, influenza vaccination, and comprehensive diabetes care.⁶ PCC allows for better health outcomes, producing greater patient and professional satisfaction, improving treatment adherence, and reducing costs. If PCC were a drug or a device, it would have an IA indication in all clinical guidelines. It is difficult to think of another measure that provides so much benefit. However, PCC is not a drug; it only requires planning and will. Scientific societies, medical associations, academic institutions, and patients’ associations should demand PCC.

References
1. Leniz J, May P, Gullifiord M, Sleeman KE. Continuity of Primary Care and end-of-life care costs in dementia: a cohort study. Br J Gen Pract 2025 Oct 24:BJGP.2025.0218. DOI: 10.3399/BJGP.2025.0218. Epub ahead of print.
2. Baker R, Freeman GK, Haggerty JL, Bankart MJ, Noc...
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We read with great interest the article by Leniz et al.¹ The authors show how primary care continuity (PCC) is associated to lower total costs and might contribute to reduce hospital admissions and costs among people with dementia in their last year of life. This important study adds to previous data supporting the benefit of PCC. We already have evidence showing that PCC is associated with increased survival.^2,3 Furthermore, PCC reduces hospitalizations,^4,5 emergency department visits,⁵ and improves cancer screening, influenza vaccination, and comprehensive diabetes care.⁶ PCC allows for better health outcomes, producing greater patient and professional satisfaction, improving treatment adherence, and reducing costs. If PCC were a drug or a device, it would have an IA indication in all clinical guidelines. It is difficult to think of another measure that provides so much benefit. However, PCC is not a drug; it only requires planning and will. Scientific societies, medical associations, academic institutions, and patients’ associations should demand PCC.

References
1. Leniz J, May P, Gullifiord M, Sleeman KE. Continuity of Primary Care and end-of-life care costs in dementia: a cohort study. Br J Gen Pract 2025 Oct 24:BJGP.2025.0218. DOI: 10.3399/BJGP.2025.0218. Epub ahead of print.
2. Baker R, Freeman GK, Haggerty JL, Bankart MJ, Nockels KH. Primary medical care continuity and patient mortality: a systematic review. Br J Gen Pract 2020;70:e600-e611.
3. Pereira Gray DJ, Sidaway-Lee K, White E, Thorne A, Evans PH. Continuity of care with doctors-a matter of life and death? A systematic review of continuity of care and mortality. BMJ Open 2018;8:e021161.
4. Hetlevik Ø, Holmås TH, Monstad K. Continuity of care, measurement and association with hospital admission and mortality: a registry-based longitudinal cohort study. BMJ Open 2021;11:e051958.
5. McDonald T, Ronksley PE, Cook LL, et al. The impact of primary care clinic and family physician continuity on patient health outcomes: a retrospective analysis from Alberta, Canada. Ann Fam Med 2024;22:223-229.
6. Wyman CS, Djerboua M, Clemens KK, Harel Z, Sood MM, Silver SA. Association of Primary Care Continuity With Home Dialysis, Transplantation, and Utilization of Medical Services for Patients Starting Hemodialysis. Kidney Med 2025;7:101015. DOI: 10.1016/j.xkme.2025.101015.
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Competing Interests: None declared.