Entry into long-term care disrupts primary care continuity-but only at entry: a national cohort study of transitional and post-entry continuity in facility- and home-based care in Australia.

Abstract (English)

BACKGROUND: Continuity of primary care is central to older adults' health and wellbeing, but entry into long-term care can disrupt established care relationships. OBJECTIVES: This study aimed to characterize how continuity of care evolves across the transition into long-term care and the post-entry period, comparing facility-based and home-based care, with analyses stratified by metropolitan and non-metropolitan location. METHODS: A national cohort study of Australians aged ≥65 who entered long-term care in 2019 and had at least three primary care visits within 6 months was conducted. Transitional continuity was defined by whether individuals continued seeing their pre-entry provider. Post-entry continuity was measured using the Usual Provider Index. Cohort differences were examined using regression models. RESULTS: Among 69 081 entrants (home-based = 27 915; facility-based = 41 166), 72% of those entering facilities changed to a new provider, compared with 10% in home-based long-term care, p < .001. In facility-based long-term care, switching to a new provider was more common in metropolitan areas than in non-metropolitan areas. Post-entry continuity was high in both settings, with 78%-80% of visits delivered by a usual provider. CONCLUSIONS: Entry into facility-based long-term care substantially disrupts established primary care relationships, but continuity is rapidly re-established after entry. The greater disruption observed in metropolitan areas suggests that factors beyond relocation, such as primary care availability and delivery models, shape transitional continuity. These findings identify long-term care entry as a key intervention point while indicating that post-entry care models effectively consolidate continuity.