Research Snapshot: Is continuity of primary care linked to outcomes for adolescents with severe mental illness transitioning to adult care?

What you need to know

In Canada, young people transition from pediatric to adult care services when they turn 18. There is a lack of evidence about whether having the same primary care provider throughout this transition period improves health outcomes in youth with mental illness. Ontario researchers used administrative health data to find out if there is a relationship between mental health outcomes and primary care continuity. They found that young people with severe mental illness had better outcomes if they received continuous care from a primary care doctor during the transition to adult care.

 

This Research Snapshot looks at the article, "Association of Primary Care Continuity with Outcomes Following Transition to Adult Care for Adolescents with Severe Mental Illness” which was published in The JAMA Network Open in 2019. Read it below or download the PDF

Research Snapshots are brief, clear language summaries of research articles, presented in a user-friendly format.

What is this research about? 

There is a lack of evidence to support whether the continuity of primary care improves mental health outcomes in youth with mental illness during the time of transition to adult care services at age 18. 

Ontario researchers looked at administrative health data to find out if there is a relationship between continuity of primary care and mental health outcomes in transitioned-aged youth who receive continuous primary care.

What did the researchers do? 

The researchers used Ontario’s administrative health data for adolescents aged 12 to 26 years from April 2002 until April 2014. Based on the primary care each person received when they transitioned out of pediatric care services (ages 17 -18), the researchers divided the youth into the following three groups: 

  • Continuous primary care. 
  • Discontinuous primary care.
  • No primary care during the transition period.


The researchers focused on the rate of mental health-related hospitalizations and emergency department visits, patient demographics (e.g., age, sex, rural residence, and neighborhood income), as well as health service use.

What did the researchers find? 

The researchers analyzed data from 8,409 adolescents with severe mental illness with an average age of 14 years. Of these, 68% were female.

The findings were as follows:

  • 83% of adolescents transitioned from a pediatrician to a family physician.
  • 5% of adolescents did not see any primary care physician during transition. 
  • 59% of adolescents who had no primary care physician successfully transitioned to a family physician during the transition period.  
  • Adolescents with schizophrenia had less continuity of care.
  • 65% of youths had continuous primary care, 28% had discontinuous primary care, and 6% had no primary care during the transition period.
  • 57% of youths with no primary care practitioner were male, with lower socioeconomic status, living in a rural area. 


Overall, adolescents with no primary care provider or discontinuous primary care during the transition years had higher rates of mental health-related hospitalizations compared with those who received continuous care. There was a 30% increased rate of mental health-related hospitalizations in young adulthood for those with no primary care doctor during transition (as compared to those with continuous care), and 20% increased rate of mental health-related emergency department visits.

Limitations and next steps 

The researchers state that the findings should be used with caution and may not be generalizable to all transitioned-aged youth, since only those youth with severe mental illness were included. Youth who received primary care from community health centres or telemedicine mental health services were excluded.

How can you use this research? 

Primary care is often overlooked in transition process and hasn’t been a major focus of research. This study suggests that primary care practitioners have an important role to play in the transition to adult care for youth with mental illness. It’s important that youth not only have access to a primary care practitioner but, ideally, see the same person over time during the transition period to adult care. 

About the researchers

Alène Toulany,1,2,3 Thérèse A. Stukel,2,4 Paul Kurdyak,2,4,5,6 Longdi Fu,2,4,5,6 Astrid Guttmann2,3,4,7

  1. Division of Adolescent Medicine, Hospital for Sick Children, Toronto, Ontario.
  2. Institute for Clinical Evaluative Science, Toronto, Ontario.
  3. Department of Pediatrics, University of Toronto, Toronto, Ontario.
  4. Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario.
  5. Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario.
  6. Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario.
  7. Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario.

Keywords  

Adolescent medicine, adolescent health, transition, transfer, adult care services, primary care

This Research Snapshot is based on the article, “Association of Primary Care Continuity with Outcomes Following Transition to Adult Care for Adolescents with Severe Mental Illness” which was published in The JAMA Network Open in 2019. doi:10.1001/jamanetworkopen.2019.8415. This summary was written by Rupinder Chera.