{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T17:52:52Z","timestamp":1792173172103,"version":"4.4.0"},"reference-count":44,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["180345"],"award-info":[{"award-number":["180345"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Family physicians provide most outpatient care in patients\u2019 last year of life, but it remains unclear how geographic distance between patients and their physicians affects continuity of care. Patients living farther from care providers may experience reduced access and more fragmented care. This study examined whether geographic proximity to a family physician is associated with relational continuity of outpatient care in the last year of life.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a population\u2011level retrospective cohort study of adults who died in Ontario, Canada, from 2021 to 2024, using linked health administrative data. Geographic proximity was measured using quartiles of the shortest driving distance (km) between each patient\u2019s residence and their family physician\u2019s practice location. Relational continuity was assessed using established measures capturing the concentration of visits, dispersion of care across physicians, and the temporal regularity of visits. Associations were estimated using proportional\u2011odds regression models adjusted for demographic, socioeconomic, and clinical factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 400,499 patients, the mean age at death was 76.0 years, 52.2% were male, the mean (SD) distance to their family physician was 25.5 (92.0) km, with the highest quartile residing more than 14.2 km away from their family physician. Greater distance was associated with modestly lower relational continuity: each one-quartile increase in distance was linked to lower odds of higher continuity with the usual family physician (cOR: 0.88, 95%CI: 0.87, 0.88). Sensitivity analyses using travel time and Euclidean distance produced consistent findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Geographic proximity is a significant determinant of outpatient continuity near the end of life. Patients living farther from their family physicians experience more fragmented care, underscoring the need for system-level strategies to reduce geographic barriers, including improved local access to primary care and enhanced virtual-care models.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0360638","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T17:28:10Z","timestamp":1792171690000},"page":"e0360638","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Measuring geographic proximity to family medicine and continuity of care in the last year of life: A population-level retrospective cohort study using Canadian health administrative data"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2853-6881","authenticated-orcid":true,"given":"Shuaib","family":"Hafid","sequence":"first","affiliation":[{"name":"McMaster University","place":["Hamilton, Ontario, Canada"],"department":["Department of Family Medicine"]},{"name":"McMaster University","place":["Hamilton, Ontario, Canada"],"department":["Department of Health Research Methods, Evidence, and Impact"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5855-5461","authenticated-orcid":true,"given":"Lawrence","family":"Mbuagbaw","sequence":"additional","affiliation":[{"name":"McMaster University","place":["Hamilton, Ontario, Canada"],"department":["Department of Health Research Methods, Evidence, and Impact"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6441-7863","authenticated-orcid":true,"given":"Bruce","family":"Newbold","sequence":"additional","affiliation":[{"name":"McMaster University","place":["Hamilton, Ontario, Canada"],"department":["School of Earth, Environment, & Society"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Costa","sequence":"additional","affiliation":[{"name":"McMaster University","place":["Hamilton, Ontario, Canada"],"department":["Department of Health Research Methods, Evidence, and Impact"]},{"name":"ICES McMaster","place":["Hamilton, Ontario, Canada"]},{"name":"St. Joseph\u2019s Health System","place":["Hamilton, Ontario, Canada"],"department":["Centre for Integrated Care"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Gayowsky","sequence":"additional","affiliation":[{"name":"ICES","place":["Toronto, Ontario, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Gozdyra","sequence":"additional","affiliation":[{"name":"ICES","place":["Toronto, Ontario, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron","family":"Jones","sequence":"additional","affiliation":[{"name":"McMaster University","place":["Hamilton, Ontario, Canada"],"department":["Department of Health Research Methods, Evidence, and Impact"]},{"name":"ICES McMaster","place":["Hamilton, Ontario, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarina R.","family":"Isenberg","sequence":"additional","affiliation":[{"name":"University of Ottawa","place":["Ottawa, Ontario, Canada"],"department":["Department of Medicine"]},{"name":"Bruy\u00e8re Health Research Institute","place":["Ottawa, Ontario, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Gallagher","sequence":"additional","affiliation":[{"name":"McMaster University","place":["Hamilton, Ontario, Canada"],"department":["Department of Family Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8127-5492","authenticated-orcid":true,"given":"Michelle","family":"Howard","sequence":"additional","affiliation":[{"name":"McMaster University","place":["Hamilton, Ontario, Canada"],"department":["Department of Family Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,16]]},"reference":[{"issue":"2","key":"pone.0360638.ref001","doi-asserted-by":"crossref","first-page":"75","DOI":"10.3747\/co.24.3447","article-title":"The role of family physicians in cancer care: perspectives of primary and specialty care providers","volume":"24","author":"J Easley","year":"2017","journal-title":"Curr Oncol"},{"key":"pone.0360638.ref002","article-title":"Coordination of cancer care between family physicians and cancer specialists: Importance of communication","author":"J Easley","year":"2016","journal-title":"Canadian Family Physician"},{"issue":"1","key":"pone.0360638.ref003","doi-asserted-by":"crossref","first-page":"48","DOI":"10.3747\/co.26.4687","article-title":"Integrating primary care providers through the seasons of survivorship","volume":"26","author":"G Chaput","year":"2019","journal-title":"Curr Oncol"},{"issue":"3","key":"pone.0360638.ref004","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1007\/s11606-021-06914-2","article-title":"From Passive Gatekeeper to Quarterback: Evolving Perceptions of Primary Care Among Medical Students in Longitudinal Outpatient Clerkships","volume":"37","author":"BL Henschen","year":"2022","journal-title":"J Gen Intern Med"},{"issue":"2","key":"pone.0360638.ref005","doi-asserted-by":"crossref","DOI":"10.9778\/cmajo.20210039","article-title":"Intensity of outpatient physician care in the last year of life: a population-based retrospective descriptive study","volume":"9","author":"M Howard","year":"2021","journal-title":"CMAJ Open"},{"issue":"7425","key":"pone.0360638.ref006","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1136\/bmj.327.7425.1219","article-title":"Continuity of care: a multidisciplinary review","volume":"327","author":"JL Haggerty","year":"2003","journal-title":"BMJ"},{"issue":"3","key":"pone.0360638.ref007","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1370\/afm.1499","article-title":"Experienced continuity of care when patients see multiple clinicians: a qualitative metasummary","volume":"11","author":"JL Haggerty","year":"2013","journal-title":"Ann Fam Med"},{"key":"pone.0360638.ref008","volume-title":"Geographic Location Methods Review: Summary Report","author":"Ontario HQ","year":"2019"},{"key":"pone.0360638.ref009","volume-title":"Statistical Area Classification (SAC)","author":"Statistics C","year":"2021"},{"key":"pone.0360638.ref010","author":"Ontario Medical Association Economics D","year":"2009"},{"issue":"1","key":"pone.0360638.ref011","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1111\/j.1748-0361.2011.00371.x","article-title":"Is distance to provider a barrier to care for medicaid patients with breast, colorectal, or lung cancer?","volume":"28","author":"JF Scoggins","year":"2012","journal-title":"J Rural Health"},{"key":"pone.0360638.ref012","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1186\/1471-2458-6-198","article-title":"The use of insulin declines as patients live farther from their source of care: results of a survey of adults with type 2 diabetes","volume":"6","author":"B Littenberg","year":"2006","journal-title":"BMC Public Health"},{"issue":"4","key":"pone.0360638.ref013","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1111\/j.1525-1497.2006.00386.x","article-title":"Driving distance as a barrier to glycemic control in diabetes","volume":"21","author":"K Strauss","year":"2006","journal-title":"J Gen Intern Med"},{"issue":"12","key":"pone.0360638.ref014","doi-asserted-by":"crossref","first-page":"1378","DOI":"10.1634\/theoncologist.2015-0110","article-title":"Distance as a Barrier to Cancer Diagnosis and Treatment: Review of the Literature","volume":"20","author":"M Ambroggi","year":"2015","journal-title":"Oncologist"},{"issue":"3","key":"pone.0360638.ref015","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1634\/theoncologist.2013-0343","article-title":"Effect of place of residence and treatment on survival outcomes in patients with diffuse large B-cell lymphoma in British Columbia","volume":"19","author":"B Lee","year":"2014","journal-title":"Oncologist"},{"issue":"37","key":"pone.0360638.ref016","doi-asserted-by":"crossref","DOI":"10.1503\/cmaj.250265","article-title":"Distance to primary care and its association with health care use and quality of care in Ontario: a cross-sectional study","volume":"197","author":"A Gupta","year":"2025","journal-title":"CMAJ"},{"issue":"10","key":"pone.0360638.ref017","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1001885","article-title":"The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement","volume":"12","author":"EI Benchimol","year":"2015","journal-title":"PLoS Med"},{"issue":"12","key":"pone.0360638.ref018","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0336790","article-title":"Measuring geographic proximity and continuity with family medicine at end-of-life: Protocol for a population-level retrospective cohort study using Canadian Health Administrative Data","volume":"20","author":"S Hafid","year":"2025","journal-title":"PLoS One"},{"issue":"4","key":"pone.0360638.ref019","doi-asserted-by":"crossref","DOI":"10.9778\/cmajo.20210294","article-title":"Continuity of physician care over the last year of life for different cause-of-death categories: a retrospective population-based study","volume":"10","author":"M Howard","year":"2022","journal-title":"CMAJ Open"},{"issue":"5","key":"pone.0360638.ref020","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1093\/fampra\/cmz002","article-title":"Regularity of contact with GPs: Measurement approaches to improve valid associations with hospitalization","volume":"36","author":"D Youens","year":"2019","journal-title":"Fam Pract"},{"issue":"4","key":"pone.0360638.ref021","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1097\/00005650-197704000-00010","article-title":"A quantitative measure of continuity of care","volume":"15","author":"TW Bice","year":"1977","journal-title":"Med Care"},{"key":"pone.0360638.ref022","first-page":"1","article-title":"Associations between continuity of primary and specialty physician care and use of hospital-based care among community-dwelling older adults with complex care needs","author":"A Jones","year":"2020","journal-title":"PLoS ONE"},{"issue":"2","key":"pone.0360638.ref023","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1177\/1077558705285294","article-title":"Indices for continuity of care: a systematic review of the literature","volume":"63","author":"SH Jee","year":"2006","journal-title":"Med Care Res Rev"},{"key":"pone.0360638.ref024","author":"Z Bobbitt","year":"2021"},{"key":"pone.0360638.ref025","author":"Center for Evidence-Based M","year":"2025"},{"key":"pone.0360638.ref026","volume-title":"Statistical power analysis for the behavioral sciences","author":"J Cohen","year":"1988","edition":"2"},{"key":"pone.0360638.ref027","year":"2026"},{"issue":"9","key":"pone.0360638.ref028","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.1111\/j.1464-5491.2011.03568.x","article-title":"Using the Johns Hopkins\u2019 Aggregated Diagnosis Groups (ADGs) to predict 1-year mortality in population-based cohorts of patients with diabetes in Ontario, Canada","volume":"29","author":"PC Austin","year":"2012","journal-title":"Diabet Med"},{"key":"pone.0360638.ref029","volume-title":"Python","author":"Foundation PS","year":"2025"},{"issue":"6","key":"pone.0360638.ref030","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1089\/109662103322654794","article-title":"Primary care continuity and location of death for those with cancer","volume":"6","author":"F Burge","year":"2003","journal-title":"J Palliat Med"},{"issue":"8","key":"pone.0360638.ref031","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1097\/00005650-200308000-00012","article-title":"Family physician continuity of care and emergency department use in end-of-life cancer care","volume":"41","author":"F Burge","year":"2003","journal-title":"Med Care"},{"issue":"2","key":"pone.0360638.ref032","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1177\/0269216313493125","article-title":"Are family physician visits and continuity of care associated with acute care use at end-of-life? A population-based cohort study of homecare cancer patients","volume":"28","author":"U Almaawiy","year":"2014","journal-title":"Palliat Med"},{"issue":"5","key":"pone.0360638.ref033","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1007\/s10900-013-9681-1","article-title":"Traveling towards disease: transportation barriers to health care access","volume":"38","author":"ST Syed","year":"2013","journal-title":"J Community Health"},{"key":"pone.0360638.ref034","article-title":"Modifying continuity of care indices for adults with organ failure nearing the end of life: a retrospective population-based study in Ontario, Canada","author":"S Hafid","year":"2026","journal-title":"BMJ Open"},{"issue":"8","key":"pone.0360638.ref035","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1097\/MLR.0000000000002334","article-title":"Association Between Team-Based Continuity of Care Measures and End-of-Life Health Care Outcomes: A Retrospective Cohort Study in Ontario, Canada","volume":"64","author":"S Hafid","year":"2026","journal-title":"Med Care"},{"issue":"10","key":"pone.0360638.ref036","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.124.038189","article-title":"Patterns of Health Care Delivery Among Adults With Heart Failure in the Last Year of Life: A Retrospective Population-Based Study","volume":"14","author":"S Hafid","year":"2025","journal-title":"J Am Heart Assoc"},{"issue":"2","key":"pone.0360638.ref037","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1080\/24745332.2024.2437412","article-title":"Care utilization patterns among patients dying with advanced chronic obstructive pulmonary disease","volume":"9","author":"A Fernandes","year":"2025","journal-title":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine"},{"issue":"3","key":"pone.0360638.ref038","doi-asserted-by":"crossref","DOI":"10.1093\/fampra\/cmag014","article-title":"Measuring the relationship between outpatient family physician visit regularity and acute care utilization during the end of life: a population-level retrospective cohort study","volume":"43","author":"S Hafid","year":"2026","journal-title":"Fam Pract"},{"issue":"1","key":"pone.0360638.ref039","doi-asserted-by":"crossref","first-page":"11","DOI":"10.46747\/cfp.690111","article-title":"Our role in making the Canadian health care system one of the world\u2019s best","volume":"69","author":"RH Glazier","year":"2023","journal-title":"Can Fam Physician"},{"issue":"2","key":"pone.0360638.ref040","article-title":"Biopsy of Canada\u2019s family physician shortage","volume":"11","author":"K Li","year":"2023","journal-title":"Fam Med Community Health"},{"key":"pone.0360638.ref041","volume-title":"Ontario\u2019s Primary Care Action Plan: 1-year progress update","author":"Government of Ontario","year":"2026"},{"key":"pone.0360638.ref042","doi-asserted-by":"crossref","DOI":"10.2196\/55007","article-title":"Uses of Virtual Care in Primary Care: Scoping Review","volume":"27","author":"P Agarwal","year":"2025","journal-title":"J Med Internet Res"},{"issue":"5","key":"pone.0360638.ref043","doi-asserted-by":"crossref","first-page":"101067","DOI":"10.1016\/j.hlpt.2025.101067","article-title":"The economic value of virtual primary healthcare services for rural populations: A systematic review","volume":"14","author":"D Simpson","year":"2025","journal-title":"Health Policy and Technology"},{"key":"pone.0360638.ref044","volume-title":"Providing More Care, Protecting Seniors, and Building More Beds Act, 2021","year":"2021"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0360638","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T17:28:19Z","timestamp":1792171699000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0360638"}},"subtitle":[],"editor":[{"given":"Bruno Pereira","family":"Nunes","sequence":"first","affiliation":[{"name":"University of Illinois Urbana-Champaign","place":["UNITED STATES OF AMERICA"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,10,16]]},"references-count":44,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,10,16]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0360638","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,16]]}}}