Which aspects of continuity of care in primary care are associated with better self-rated health? A cross-sectional study among older adults in Berlin.

Abstract

Background: Global population ageing and rapid urbanization are increasing the prevalence of multimorbidity and complex health needs among older adults, emphasizing the importance of accessible and high-quality primary care. Continuity of care (CoC) is a core feature of person-centered primary care and has been linked to improved health outcomes, reduced mortality, and lower health care utilization. While general use of primary care has been associated with better self-rated health, evidence on the specific role of continuity of primary care remains limited. This study examined the association between CoC in primary care and self-rated health among adults aged 65 years and older living in three neighborhoods in Berlin, Germany.

Methods: Cross-sectional data were drawn from the baseline survey of the Ageing Well study (December 2023 - June 2024, December 2024 - June 2025) in Berlin. 837 participants completed standardized face-to-face interviews. CoC was assessed by duration of care at a general practitioner's practice and duration of care with the same general practitioner. Self-rated health was measured using a single-item five-point scale. Linear regression models were fitted, adjusting for age, gender, subjective social status, lifetime morbidity, symptoms of depression, and anxiety. Missing data were addressed using listwise deletion.

Results: Most participants reported a general practitioner as their usual care site (84.7%), and self-rated health was most frequently rated as good (41.6%). Continuity with a general practitioner was positively associated with self-rated health, although the magnitude of the association was small (b = 0.008, 95% CI: 0.002-0.015). Lifetime morbidity explained the largest proportion of unique variance in self-rated health. Depressive symptoms were associated with poorer self-rated health, while higher subjective social status was associated with better self-rated health.

Conclusions: The association between CoC and self-rated health was small. These findings suggest that commonly used patient-reported outcomes may not adequately capture the effects of CoC in older adults. Future research should therefore consider more sensitive and process-oriented outcome measures to better capture the impact of CoC.

Clinical trial number: German Register for Clinical Studies (DRKS) (DRKS00033043, registered 16 November 2023); part of the WHO International Clinical Trials Registry Platform (WHO ICTRP), https://www.drks.de .