Continuity of care for all? Associations between migration background and personal continuity among persons aged 50 and older in Dutch primary care: a registry-based observational study.

Abstract

Background: Continuity of care (CoC) is linked to better outcomes. Particularly, older adults and those with chronic conditions, like type 2 diabetes (T2D) and dementia, may benefit from CoC. Individuals with a migration background (MB) face challenges in accessing adequate healthcare. Our aim was to study associations between MB and personal continuity of general practitioner (GP) care among older adults, and in subgroups with T2D and dementia.

Methods: Observational cohort study (2013-8) based on electronic records from 48 Dutch general practices linked to data from Statistics Netherlands. We specifically compared adults who migrated to the Netherlands to those without MB. The Herfindahl-Hirschman Index (HHI; low/medium/high) was used to measure CoC. We used multilevel ordinal regression to estimate associations between MB and CoC, adjusted for follow-up time/age/gender/comorbidity/income/practice.

Results: 46 663 individuals aged ≥50 years were included: 72.9% with no MB, 5.7% with Surinamese, 4.3% Moroccan, 2.7% Turkish, 5.1% European, and 9.3% other MB. Compared with those without MB, persons with a Moroccan MB had lower odds of having moderate or high CoC [odds ratio (OR) 0.81, 95% CI 0.74-0.89], and persons with a European MB had higher odds of having moderate or high CoC (OR 1.16, 95% CI 1.07-1.26). Persons with a Moroccan MB in the T2D subgroup had lower odds of having moderate or high CoC (OR 0.75, 95% CI 0.64-0.89). No differences were found in the dementia subgroup.

Conclusions: This study reveals inequalities in personal continuity of GP care by MB in the Netherlands. Interventions to improve CoC should actively incorporate MB groups to promote equitable CoC.