Observational studyCMAJ open
Association between continuity and access in primary care: a retrospective cohort study.
Open access · diamondAbstract readObservational Study
In one paragraph
Observational study in CMAJ open. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 3 of them syntheses that pooled it.
0numbers the graph read from it
0cells of the map it votes in
16citing papers in PubMed, 3 pooled it
1.3field-weighted citation impact, top 18% of its field
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
16 citing papers in PubMed, 3 syntheses or guidelines pooled it, 31 citations in OpenAlex.
- How do interventions in primary care or in emergency departments impact less urgent patients' emergency care utilization? A systematic review.BMC health services research · 2026Pooled it
- Access or continuity: a zero sum game? A systematic review of the literature examining the relationship between access and continuity in primary healthcare.BMC primary care · 2025Pooled it
- Use of Electronic Medical Record Data to Create a Dashboard on Access to Primary Care.Healthcare policy = Politiques de sante · 2023Pooled it
- Healthcare Services Use and Satisfaction Among Iraqi and Syrian Refugees in San Diego: A Qualitative Study.Journal of immigrant and minority health · 2026Article
- Primary care continuity and breast cancer survival: a retrospective cohort study.Cancer causes & control : CCC · 2026Article
- Recommendations of an Independent Expert Committee for the Development of Quebec's First Government Policy on Primary Care.Healthcare management forum · 2026Article
- Continuity of Primary Care in Community Health Centers.Annals of family medicine · 2026Article
- Improving access, mixed continuity: effects of multidisciplinary teams on primary health-care in Finland - a quasi-experimental study.Scandinavian journal of primary health care · 2025Article
- Advanced Access in Primary Healthcare and Its Effects on Emergency Department Utilization: A Rapid Review.Healthcare (Basel, Switzerland) · 2025Review
- Patient preferences for key organizational features of primary cardiovascular care in Quebec: a discrete choice experiment.BMC primary care · 2025Article
- The impact of remuneration, extrinsic and intrinsic incentives on interprofessional primary care teams: results from a rapid scoping review.BMC primary care · 2025Article
- Factors associated with patients' experience of accessibility to general practice: results from a national survey in Norway.BMC health services research · 2024Article
- How Primary Healthcare Sector is Organized at the Territorial Level in France? A Typology of Territorial Structuring.International journal of health policy and management · 2024Article
- Article
- Differences between recorded diagnoses of patients of an emergency department and office-hours primary care doctors: a register-based study in a Finnish town.International journal of circumpolar health · 2021Article
- Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
13 authors at 5 institutions in 4 countries.
Lisa L CookApplied Research & Evaluation Services, Primary Health Care (L. Cook, C. Cook), Alberta Health Services; Faculty of Health Sciences (L. Cook, Spenceley), University of Lethbridge, Lethbridge, Alta.; Applied Research & Evaluation Services, Primary Health Care (Golonka), Alberta Health Services, Edmonton, Alta.; Applied Research & Evaluation Services, Primary Health Care (Walker), Alberta Health Services; Cumming School of Medicine (Walker, Faris), University of Calgary; Health Services Statistical & Analytics Methods, Analytics, Data Integration, Measurement & Reporting (Faris), Alberta Health Services, Calgary, Alta.; Enhancing Care in the Community (Lewanczuk), Alberta Health Services; Department of Medicine (Lewanczuk), University of Alberta, Edmonton, Alta.; Chinook Primary Care Network (Wedel, Byers, Collins); Primary Health Care Integration Network (Love), Alberta Health Services; Public & Primary Health Care (Andres), Alberta Health Services, Lethbridge, Alta.; Applied Research & Evaluation Services, Primary Health Care (Oddie), Alberta Health Services, Red Deer, Alta.; Faculty of Social Sciences (Oddie), University of Calgary, Calgary, Alta. Lisa.Cook@ahs.ca.
Richard P GolonkaApplied Research & Evaluation Services, Primary Health Care (L. Cook, C. Cook), Alberta Health Services; Faculty of Health Sciences (L. Cook, Spenceley), University of Lethbridge, Lethbridge, Alta.; Applied Research & Evaluation Services, Primary Health Care (Golonka), Alberta Health Services, Edmonton, Alta.; Applied Research & Evaluation Services, Primary Health Care (Walker), Alberta Health Services; Cumming School of Medicine (Walker, Faris), University of Calgary; Health Services Statistical & Analytics Methods, Analytics, Data Integration, Measurement & Reporting (Faris), Alberta Health Services, Calgary, Alta.; Enhancing Care in the Community (Lewanczuk), Alberta Health Services; Department of Medicine (Lewanczuk), University of Alberta, Edmonton, Alta.; Chinook Primary Care Network (Wedel, Byers, Collins); Primary Health Care Integration Network (Love), Alberta Health Services; Public & Primary Health Care (Andres), Alberta Health Services, Lethbridge, Alta.; Applied Research & Evaluation Services, Primary Health Care (Oddie), Alberta Health Services, Red Deer, Alta.; Faculty of Social Sciences (Oddie), University of Calgary, Calgary, Alta.
Charles M CookApplied Research & Evaluation Services, Primary Health Care (L. Cook, C. Cook), Alberta Health Services; Faculty of Health Sciences (L. Cook, Spenceley), University of Lethbridge, Lethbridge, Alta.; Applied Research & Evaluation Services, Primary Health Care (Golonka), Alberta Health Services, Edmonton, Alta.; Applied Research & Evaluation Services, Primary Health Care (Walker), Alberta Health Services; Cumming School of Medicine (Walker, Faris), University of Calgary; Health Services Statistical & Analytics Methods, Analytics, Data Integration, Measurement & Reporting (Faris), Alberta Health Services, Calgary, Alta.; Enhancing Care in the Community (Lewanczuk), Alberta Health Services; Department of Medicine (Lewanczuk), University of Alberta, Edmonton, Alta.; Chinook Primary Care Network (Wedel, Byers, Collins); Primary Health Care Integration Network (Love), Alberta Health Services; Public & Primary Health Care (Andres), Alberta Health Services, Lethbridge, Alta.; Applied Research & Evaluation Services, Primary Health Care (Oddie), Alberta Health Services, Red Deer, Alta.; Faculty of Social Sciences (Oddie), University of Calgary, Calgary, Alta.
Robin L WalkerApplied Research & Evaluation Services, Primary Health Care (L. Cook, C. Cook), Alberta Health Services; Faculty of Health Sciences (L. Cook, Spenceley), University of Lethbridge, Lethbridge, Alta.; Applied Research & Evaluation Services, Primary Health Care (Golonka), Alberta Health Services, Edmonton, Alta.; Applied Research & Evaluation Services, Primary Health Care (Walker), Alberta Health Services; Cumming School of Medicine (Walker, Faris), University of Calgary; Health Services Statistical & Analytics Methods, Analytics, Data Integration, Measurement & Reporting (Faris), Alberta Health Services, Calgary, Alta.; Enhancing Care in the Community (Lewanczuk), Alberta Health Services; Department of Medicine (Lewanczuk), University of Alberta, Edmonton, Alta.; Chinook Primary Care Network (Wedel, Byers, Collins); Primary Health Care Integration Network (Love), Alberta Health Services; Public & Primary Health Care (Andres), Alberta Health Services, Lethbridge, Alta.; Applied Research & Evaluation Services, Primary Health Care (Oddie), Alberta Health Services, Red Deer, Alta.; Faculty of Social Sciences (Oddie), University of Calgary, Calgary, Alta.
Peter FarisApplied Research & Evaluation Services, Primary Health Care (L. Cook, C. Cook), Alberta Health Services; Faculty of Health Sciences (L. Cook, Spenceley), University of Lethbridge, Lethbridge, Alta.; Applied Research & Evaluation Services, Primary Health Care (Golonka), Alberta Health Services, Edmonton, Alta.; Applied Research & Evaluation Services, Primary Health Care (Walker), Alberta Health Services; Cumming School of Medicine (Walker, Faris), University of Calgary; Health Services Statistical & Analytics Methods, Analytics, Data Integration, Measurement & Reporting (Faris), Alberta Health Services, Calgary, Alta.; Enhancing Care in the Community (Lewanczuk), Alberta Health Services; Department of Medicine (Lewanczuk), University of Alberta, Edmonton, Alta.; Chinook Primary Care Network (Wedel, Byers, Collins); Primary Health Care Integration Network (Love), Alberta Health Services; Public & Primary Health Care (Andres), Alberta Health Services, Lethbridge, Alta.; Applied Research & Evaluation Services, Primary Health Care (Oddie), Alberta Health Services, Red Deer, Alta.; Faculty of Social Sciences (Oddie), University of Calgary, Calgary, Alta.
Shannon SpenceleyApplied Research & Evaluation Services, Primary Health Care (L. Cook, C. Cook), Alberta Health Services; Faculty of Health Sciences (L. Cook, Spenceley), University of Lethbridge, Lethbridge, Alta.; Applied Research & Evaluation Services, Primary Health Care (Golonka), Alberta Health Services, Edmonton, Alta.; Applied Research & Evaluation Services, Primary Health Care (Walker), Alberta Health Services; Cumming School of Medicine (Walker, Faris), University of Calgary; Health Services Statistical & Analytics Methods, Analytics, Data Integration, Measurement & Reporting (Faris), Alberta Health Services, Calgary, Alta.; Enhancing Care in the Community (Lewanczuk), Alberta Health Services; Department of Medicine (Lewanczuk), University of Alberta, Edmonton, Alta.; Chinook Primary Care Network (Wedel, Byers, Collins); Primary Health Care Integration Network (Love), Alberta Health Services; Public & Primary Health Care (Andres), Alberta Health Services, Lethbridge, Alta.; Applied Research & Evaluation Services, Primary Health Care (Oddie), Alberta Health Services, Red Deer, Alta.; Faculty of Social Sciences (Oddie), University of Calgary, Calgary, Alta.
Richard LewanczukApplied Research & Evaluation Services, Primary Health Care (L. Cook, C. Cook), Alberta Health Services; Faculty of Health Sciences (L. Cook, Spenceley), University of Lethbridge, Lethbridge, Alta.; Applied Research & Evaluation Services, Primary Health Care (Golonka), Alberta Health Services, Edmonton, Alta.; Applied Research & Evaluation Services, Primary Health Care (Walker), Alberta Health Services; Cumming School of Medicine (Walker, Faris), University of Calgary; Health Services Statistical & Analytics Methods, Analytics, Data Integration, Measurement & Reporting (Faris), Alberta Health Services, Calgary, Alta.; Enhancing Care in the Community (Lewanczuk), Alberta Health Services; Department of Medicine (Lewanczuk), University of Alberta, Edmonton, Alta.; Chinook Primary Care Network (Wedel, Byers, Collins); Primary Health Care Integration Network (Love), Alberta Health Services; Public & Primary Health Care (Andres), Alberta Health Services, Lethbridge, Alta.; Applied Research & Evaluation Services, Primary Health Care (Oddie), Alberta Health Services, Red Deer, Alta.; Faculty of Social Sciences (Oddie), University of Calgary, Calgary, Alta.
Robert WedelApplied Research & Evaluation Services, Primary Health Care (L. Cook, C. Cook), Alberta Health Services; Faculty of Health Sciences (L. Cook, Spenceley), University of Lethbridge, Lethbridge, Alta.; Applied Research & Evaluation Services, Primary Health Care (Golonka), Alberta Health Services, Edmonton, Alta.; Applied Research & Evaluation Services, Primary Health Care (Walker), Alberta Health Services; Cumming School of Medicine (Walker, Faris), University of Calgary; Health Services Statistical & Analytics Methods, Analytics, Data Integration, Measurement & Reporting (Faris), Alberta Health Services, Calgary, Alta.; Enhancing Care in the Community (Lewanczuk), Alberta Health Services; Department of Medicine (Lewanczuk), University of Alberta, Edmonton, Alta.; Chinook Primary Care Network (Wedel, Byers, Collins); Primary Health Care Integration Network (Love), Alberta Health Services; Public & Primary Health Care (Andres), Alberta Health Services, Lethbridge, Alta.; Applied Research & Evaluation Services, Primary Health Care (Oddie), Alberta Health Services, Red Deer, Alta.; Faculty of Social Sciences (Oddie), University of Calgary, Calgary, Alta.
Rebecca LoveApplied Research & Evaluation Services, Primary Health Care (L. Cook, C. Cook), Alberta Health Services; Faculty of Health Sciences (L. Cook, Spenceley), University of Lethbridge, Lethbridge, Alta.; Applied Research & Evaluation Services, Primary Health Care (Golonka), Alberta Health Services, Edmonton, Alta.; Applied Research & Evaluation Services, Primary Health Care (Walker), Alberta Health Services; Cumming School of Medicine (Walker, Faris), University of Calgary; Health Services Statistical & Analytics Methods, Analytics, Data Integration, Measurement & Reporting (Faris), Alberta Health Services, Calgary, Alta.; Enhancing Care in the Community (Lewanczuk), Alberta Health Services; Department of Medicine (Lewanczuk), University of Alberta, Edmonton, Alta.; Chinook Primary Care Network (Wedel, Byers, Collins); Primary Health Care Integration Network (Love), Alberta Health Services; Public & Primary Health Care (Andres), Alberta Health Services, Lethbridge, Alta.; Applied Research & Evaluation Services, Primary Health Care (Oddie), Alberta Health Services, Red Deer, Alta.; Faculty of Social Sciences (Oddie), University of Calgary, Calgary, Alta.
Cheryl AndresApplied Research & Evaluation Services, Primary Health Care (L. Cook, C. Cook), Alberta Health Services; Faculty of Health Sciences (L. Cook, Spenceley), University of Lethbridge, Lethbridge, Alta.; Applied Research & Evaluation Services, Primary Health Care (Golonka), Alberta Health Services, Edmonton, Alta.; Applied Research & Evaluation Services, Primary Health Care (Walker), Alberta Health Services; Cumming School of Medicine (Walker, Faris), University of Calgary; Health Services Statistical & Analytics Methods, Analytics, Data Integration, Measurement & Reporting (Faris), Alberta Health Services, Calgary, Alta.; Enhancing Care in the Community (Lewanczuk), Alberta Health Services; Department of Medicine (Lewanczuk), University of Alberta, Edmonton, Alta.; Chinook Primary Care Network (Wedel, Byers, Collins); Primary Health Care Integration Network (Love), Alberta Health Services; Public & Primary Health Care (Andres), Alberta Health Services, Lethbridge, Alta.; Applied Research & Evaluation Services, Primary Health Care (Oddie), Alberta Health Services, Red Deer, Alta.; Faculty of Social Sciences (Oddie), University of Calgary, Calgary, Alta.
Susan D ByersApplied Research & Evaluation Services, Primary Health Care (L. Cook, C. Cook), Alberta Health Services; Faculty of Health Sciences (L. Cook, Spenceley), University of Lethbridge, Lethbridge, Alta.; Applied Research & Evaluation Services, Primary Health Care (Golonka), Alberta Health Services, Edmonton, Alta.; Applied Research & Evaluation Services, Primary Health Care (Walker), Alberta Health Services; Cumming School of Medicine (Walker, Faris), University of Calgary; Health Services Statistical & Analytics Methods, Analytics, Data Integration, Measurement & Reporting (Faris), Alberta Health Services, Calgary, Alta.; Enhancing Care in the Community (Lewanczuk), Alberta Health Services; Department of Medicine (Lewanczuk), University of Alberta, Edmonton, Alta.; Chinook Primary Care Network (Wedel, Byers, Collins); Primary Health Care Integration Network (Love), Alberta Health Services; Public & Primary Health Care (Andres), Alberta Health Services, Lethbridge, Alta.; Applied Research & Evaluation Services, Primary Health Care (Oddie), Alberta Health Services, Red Deer, Alta.; Faculty of Social Sciences (Oddie), University of Calgary, Calgary, Alta.
Tim CollinsApplied Research & Evaluation Services, Primary Health Care (L. Cook, C. Cook), Alberta Health Services; Faculty of Health Sciences (L. Cook, Spenceley), University of Lethbridge, Lethbridge, Alta.; Applied Research & Evaluation Services, Primary Health Care (Golonka), Alberta Health Services, Edmonton, Alta.; Applied Research & Evaluation Services, Primary Health Care (Walker), Alberta Health Services; Cumming School of Medicine (Walker, Faris), University of Calgary; Health Services Statistical & Analytics Methods, Analytics, Data Integration, Measurement & Reporting (Faris), Alberta Health Services, Calgary, Alta.; Enhancing Care in the Community (Lewanczuk), Alberta Health Services; Department of Medicine (Lewanczuk), University of Alberta, Edmonton, Alta.; Chinook Primary Care Network (Wedel, Byers, Collins); Primary Health Care Integration Network (Love), Alberta Health Services; Public & Primary Health Care (Andres), Alberta Health Services, Lethbridge, Alta.; Applied Research & Evaluation Services, Primary Health Care (Oddie), Alberta Health Services, Red Deer, Alta.; Faculty of Social Sciences (Oddie), University of Calgary, Calgary, Alta.
Scott OddieApplied Research & Evaluation Services, Primary Health Care (L. Cook, C. Cook), Alberta Health Services; Faculty of Health Sciences (L. Cook, Spenceley), University of Lethbridge, Lethbridge, Alta.; Applied Research & Evaluation Services, Primary Health Care (Golonka), Alberta Health Services, Edmonton, Alta.; Applied Research & Evaluation Services, Primary Health Care (Walker), Alberta Health Services; Cumming School of Medicine (Walker, Faris), University of Calgary; Health Services Statistical & Analytics Methods, Analytics, Data Integration, Measurement & Reporting (Faris), Alberta Health Services, Calgary, Alta.; Enhancing Care in the Community (Lewanczuk), Alberta Health Services; Department of Medicine (Lewanczuk), University of Alberta, Edmonton, Alta.; Chinook Primary Care Network (Wedel, Byers, Collins); Primary Health Care Integration Network (Love), Alberta Health Services; Public & Primary Health Care (Andres), Alberta Health Services, Lethbridge, Alta.; Applied Research & Evaluation Services, Primary Health Care (Oddie), Alberta Health Services, Red Deer, Alta.; Faculty of Social Sciences (Oddie), University of Calgary, Calgary, Alta.
Alberta Health Services · CAPrimary Health Care · QAPrimary HealthCare · MTUniversity of Calgary · CAWalker (United States) · US
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundContinuity of care is a tenet of primary care. Our objective was to explore the relation between a change in access to a primary care physician and continuity of care.
methodsWe conducted a retrospective cohort study among physicians in a primary care network in southwest Alberta who measured access consistently between 2009 and 2016. We used time to the third next available appointment as a measure of access to physicians. We calculated the provider and clinic continuity, discontinuity and emergency department use based on the physicians' own panels. Physicians who improved, worsened or maintained their level of access within a given year were assessed in multilevel models to determine the association with continuity of care at the physician and clinic levels and the emergency department.
resultsWe analyzed data from 190 primary care physicians. Physicians with improved access increased provider continuity by 6.8% per year, reduced discontinuity by 2.1% per year, and decreased emergency department encounters by 78 visits per 1000 patients per year compared to physicians with stable access. Physicians with worsening access had a 6.2% decrease in provider continuity and an increased number of emergency department encounters (64 visits per 1000 panelled patients per year) compared to physicians with stable access.
interpretationChanges in access to primary care can affect whether patients seek care from their own physician, from another clinic or at the emergency department. Improving access by reducing the delay in obtaining an appointment with one's primary care physician may be one mechanism to improve continuity of care.
Indexed as
Continuity of Patient CareDelivery of Health CareHealth Services AccessibilityAdultAlbertaAppointments and SchedulesEmergency Service, HospitalFemaleHumansLinear ModelsMaleMiddle AgedPhysicians, Primary CarePrimary Health CareRetrospective Studies
Identifiers
What OpenQuestion holds
Textmetadata
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Registered trials
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.