{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T14:58:46Z","timestamp":1770649126375,"version":"3.49.0"},"reference-count":59,"publisher":"Royal College of General Practitioners","issue":"763","license":[{"start":{"date-parts":[[2019,2,12]],"date-time":"2019-02-12T00:00:00Z","timestamp":1549929600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br J Gen Pract"],"accepted":{"date-parts":[[2025,8,28]]},"published-print":{"date-parts":[[2026,2,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>End-of-life dementia care costs are expected to rise as populations age. Higher continuity of care with GPs is associated with reduced hospital admissions at the end of life, but the impact on costs is not known.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To explore the association of continuity of primary care on hospital and general practice costs in the last year of life among people with dementia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and setting<\/jats:title>\n                    <jats:p>A retrospective cohort study using a primary care dataset linked with national hospital and mortality records. Adults (aged &gt;18 years) who died in England between 2009 and 2018 with a diagnosis of dementia were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>The Continuity of Care Index (COCI) of GP contacts in the last year of life was calculated, which measures patterns of care across GPs. Hospital and general practice costs were calculated using average national tariffs. Costs were modelled using a multivariable generalised linear model, estimating the average marginal effect of perfect continuity over non-continuity of care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In total, 32 799 people were included. The mean age at death was 86.60 years (standard deviation [SD] 8.04\u202fyears), 64.2% (\n                      <jats:italic>n<\/jats:italic>\n                      = 21\u202f057) were female, and 56.6% (\n                      <jats:italic>n<\/jats:italic>\n                      = 18\u202f556) lived in care homes before death. The average COCI score was 0.38 (SD 0.25). People with perfect continuity had on average \u00a32097 (95% confidence interval = 1319 to 2875) lower total costs in the last year than those with non-continuity of care.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Continuity of care with GPs is associated with lower total costs and might contribute to reduce hospital admissions and costs among people with dementia in their last year of life.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3399\/bjgp.2025.0218","type":"journal-article","created":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T14:10:10Z","timestamp":1761315010000},"page":"e116-e123","source":"Crossref","is-referenced-by-count":2,"title":["Continuity of primary care and end-of-life care costs in dementia: a retrospective cohort study"],"prefix":"10.3399","volume":"76","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9315-4871","authenticated-orcid":false,"given":"Javiera","family":"Leniz","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8501-6500","authenticated-orcid":false,"given":"Peter","family":"May","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1898-9075","authenticated-orcid":false,"given":"Martin","family":"Gulliford","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9777-4373","authenticated-orcid":false,"given":"Katherine E","family":"Sleeman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1987","published-online":{"date-parts":[[2025,10,24]]},"reference":[{"key":"2026020809154978000_76.763.e116.1","unstructured":"Institute for Health Metrics and Evaluation (2023) Global Burden of Disease results. accessed. https:\/\/vizhub.healthdata.org\/gbd-results. 18 Dec 2025."},{"key":"2026020809154978000_76.763.e116.2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.330.7498.1007"},{"issue":"16","key":"2026020809154978000_76.763.e116.3","doi-asserted-by":"crossref","first-page":"1534","DOI":"10.1001\/jamainternmed.2013.8732","article-title":"Restricting symptoms in the last year of life: a prospective cohort study","volume":"173","author":"Chaudhry","year":"2013","journal-title":"JAMA Intern Med"},{"issue":"1","key":"2026020809154978000_76.763.e116.4","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1017\/S1355617724000730","article-title":"Neuropsychiatric symptoms predict rate of change in executive function in Alzheimer\u2019s disease and related dementias","volume":"31","author":"Goodwin","year":"2025","journal-title":"J Int Neuropsychol Soc"},{"key":"2026020809154978000_76.763.e116.5","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2023.1208802","article-title":"Exploring the relationship between patient-relevant outcomes and Alzheimer\u2019s disease progression assessed using the clinical dementia rating scale: a systematic literature review","volume":"14","author":"Cummings","year":"2023","journal-title":"Front Neurol"},{"key":"2026020809154978000_76.763.e116.6","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyt.2021.741059","article-title":"Prevalence of behavioral and psychological symptoms of dementia in community-dwelling dementia patients: a systematic review","volume":"12","author":"Kwon","year":"2021","journal-title":"Front Psychiatry"},{"issue":"5","key":"2026020809154978000_76.763.e116.7","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1093\/ageing\/afz052","article-title":"Understanding which people with dementia are at risk of inappropriate care and avoidable transitions to hospital near the end-of-life: a retrospective cohort study","volume":"48","author":"Leniz","year":"2019","journal-title":"Age Ageing"},{"key":"2026020809154978000_76.763.e116.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jalz.2017.06.2267"},{"key":"2026020809154978000_76.763.e116.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2021.06.012"},{"key":"2026020809154978000_76.763.e116.10","doi-asserted-by":"publisher","DOI":"10.1093\/geronb\/56.5.S285"},{"key":"2026020809154978000_76.763.e116.11","doi-asserted-by":"publisher","DOI":"10.1002\/gps.4198"},{"key":"2026020809154978000_76.763.e116.12","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.2009.01461.x"},{"issue":"3","key":"2026020809154978000_76.763.e116.13","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1111\/jgs.16909","article-title":"Association of hospitalization with long-term cognitive trajectories in older adults","volume":"69","author":"Sprung","year":"2021","journal-title":"J Am Geriatr Soc"},{"key":"2026020809154978000_76.763.e116.14","doi-asserted-by":"publisher","DOI":"10.1177\/0269216313517284"},{"key":"2026020809154978000_76.763.e116.15","unstructured":"NHS England (2019) The NHS Long Term Plan. accessed. https:\/\/webarchive.nationalarchives.gov.uk\/ukgwa\/20230418155402\/https:\/www.longtermplan.nhs.uk\/publication\/nhs-long-term-plan. 18 Dec 2025."},{"key":"2026020809154978000_76.763.e116.16","doi-asserted-by":"publisher","DOI":"10.1258\/135581906778476490"},{"key":"2026020809154978000_76.763.e116.17","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.327.7425.1219"},{"key":"2026020809154978000_76.763.e116.18","doi-asserted-by":"publisher","DOI":"10.1177\/1077558713505685"},{"key":"2026020809154978000_76.763.e116.19","doi-asserted-by":"publisher","DOI":"10.1370\/afm.2308"},{"issue":"537","key":"2026020809154978000_76.763.e116.20","first-page":"283","article-title":"Interpersonal continuity of care: a cross-sectional survey of primary care patients\u2019 preferences and their experiences","volume":"57","author":"Baker","year":"2007","journal-title":"Br J Gen Pract"},{"key":"2026020809154978000_76.763.e116.21","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000000246"},{"key":"2026020809154978000_76.763.e116.22","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2013.10059"},{"key":"2026020809154978000_76.763.e116.23","doi-asserted-by":"publisher","DOI":"10.1370\/afm.2136"},{"key":"2026020809154978000_76.763.e116.24","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.17049"},{"issue":"1","key":"2026020809154978000_76.763.e116.25","doi-asserted-by":"crossref","DOI":"10.1186\/s12877-022-03407-7","article-title":"Effects of continuity of care on hospitalizations and healthcare costs in older adults with dementia","volume":"22","author":"Chao","year":"2022","journal-title":"BMC Geriatr"},{"issue":"11","key":"2026020809154978000_76.763.e116.26","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1097\/MLR.0000000000001386","article-title":"Can continuity of care reduce hospitalization among community-dwelling older adult veterans living with dementia?","volume":"58","author":"Lei","year":"2020","journal-title":"Med Care"},{"key":"2026020809154978000_76.763.e116.27","doi-asserted-by":"publisher","DOI":"10.3399\/BJGP.2021.0715"},{"key":"2026020809154978000_76.763.e116.28","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.r254","article-title":"Over 80% of health spending in final year of life goes on hospital care, data show","volume":"388","author":"Iacobucci","year":"2025","journal-title":"BMJ"},{"key":"2026020809154978000_76.763.e116.29","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyv098"},{"key":"2026020809154978000_76.763.e116.30","unstructured":"NHS Digital (2022) Quality and Outcomes Framework QOF business rules v37.0. accessed. https:\/\/webarchive.nationalarchives.gov.uk\/ukgwa\/20221104222820\/https:\/\/digital.nhs.uk\/data-and-information\/data-collections-and-data-sets\/data-collections\/quality-and-outcomes-framework-qof#quality-and-outcome-framework-business-rules. 6 Jan 2026."},{"issue":"1","key":"2026020809154978000_76.763.e116.31","doi-asserted-by":"crossref","first-page":"337","DOI":"10.3233\/JAD-160105","article-title":"Identification of physician-diagnosed Alzheimer\u2019s disease and related dementias in population-based administrative data: a validation study using family physicians\u2019 electronic medical records","volume":"54","author":"Jaakkimainen","year":"2016","journal-title":"J Alzheimers Dis"},{"key":"2026020809154978000_76.763.e116.32","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-054281"},{"key":"2026020809154978000_76.763.e116.33","unstructured":"Department of Health and Social Care (2013) Payment by results in the NHS: a simple guide. accessed. https:\/\/www.gov.uk\/government\/publications\/simple-guide-to-payment-by-results. 18 Dec 2025."},{"key":"2026020809154978000_76.763.e116.34","unstructured":"Jones KC Weatherly H Birch S (2024) Unit costs of health and social care 2023 manual. accessed. https:\/\/kar.kent.ac.uk\/105685\/1\/The%20unit%20costs%20of%20health%20and%20social%20care_Final3.pdf. 18 Dec 2025."},{"key":"2026020809154978000_76.763.e116.35","doi-asserted-by":"publisher","DOI":"10.1177\/1077558705285294"},{"key":"2026020809154978000_76.763.e116.36","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38740.614954.55"},{"issue":"5","key":"2026020809154978000_76.763.e116.37","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1093\/ageing\/afz043","article-title":"Patterns of emergency department attendance among older people in the last three months of life and factors associated with frequent attendance: a mortality follow-back survey","volume":"48","author":"Bone","year":"2019","journal-title":"Age Ageing"},{"key":"2026020809154978000_76.763.e116.38","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cms060"},{"key":"2026020809154978000_76.763.e116.39","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0189038"},{"key":"2026020809154978000_76.763.e116.40","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0113188"},{"key":"2026020809154978000_76.763.e116.41","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp20X713417"},{"issue":"1","key":"2026020809154978000_76.763.e116.42","doi-asserted-by":"crossref","DOI":"10.1002\/trc2.12198","article-title":"Exploring costs, cost components, and associated factors among people with dementia approaching the end of life: a systematic review","volume":"7","author":"Leniz","year":"2021","journal-title":"Alzheimers Dement (N Y)"},{"issue":"3","key":"2026020809154978000_76.763.e116.43","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1111\/1475-6773.13541","article-title":"Continuity of care and health care cost among community-dwelling older adult veterans living with dementia","volume":"56","author":"Lei","year":"2021","journal-title":"Health Serv Res"},{"issue":"Suppl 2","key":"2026020809154978000_76.763.e116.44","doi-asserted-by":"crossref","first-page":"S682","DOI":"10.1007\/s11606-013-2633-8","article-title":"Does improved continuity of primary care affect clinician-patient communication in VA?","volume":"29 Suppl 2","author":"Katz","year":"2014","journal-title":"J Gen Intern Med"},{"key":"2026020809154978000_76.763.e116.45","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp11X588457"},{"key":"2026020809154978000_76.763.e116.46","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp09X420248"},{"issue":"2","key":"2026020809154978000_76.763.e116.47","doi-asserted-by":"crossref","first-page":"397","DOI":"10.3233\/JAD-140435","article-title":"Needs of people with severe dementia at the end-of-life: a systematic review","volume":"43","author":"Perrar","year":"2015","journal-title":"J Alzheimers Dis"},{"key":"2026020809154978000_76.763.e116.48","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0201051"},{"issue":"3","key":"2026020809154978000_76.763.e116.49","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1177\/0269216317736033","article-title":"End-of-life care: a qualitative study comparing the views of people with dementia and family carers","volume":"32","author":"Poole","year":"2018","journal-title":"Palliat Med"},{"key":"2026020809154978000_76.763.e116.50","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2021.103978"},{"issue":"7","key":"2026020809154978000_76.763.e116.51","doi-asserted-by":"crossref","DOI":"10.1002\/gps.5966","article-title":"Exploring access to community care and emergency department use among people with dementia: a qualitative interview study with people with dementia, and current and bereaved caregivers","volume":"38","author":"Williamson","year":"2023","journal-title":"Int J Geriatr Psychiatry"},{"key":"2026020809154978000_76.763.e116.52","doi-asserted-by":"crossref","DOI":"10.1186\/s12904-015-0028-9","article-title":"Expert views on the factors enabling good end of life care for people with dementia: a qualitative study","volume":"14","author":"Lee","year":"2015","journal-title":"BMC Palliat Care"},{"key":"2026020809154978000_76.763.e116.53","doi-asserted-by":"publisher","DOI":"10.3399\/BJGP.2020.0935"},{"key":"2026020809154978000_76.763.e116.54","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)00620-6"},{"key":"2026020809154978000_76.763.e116.55","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2011.168"},{"key":"2026020809154978000_76.763.e116.56","unstructured":"Palmer W Hemmings N Rosen R (2018) Improving access and continuity in general practice: practical and policy lessons. accessed. https:\/\/www.nuffieldtrust.org.uk\/sites\/default\/files\/2019-01\/continuing-care-summary-final-.pdf. 18 Dec 2025."},{"key":"2026020809154978000_76.763.e116.57","unstructured":"NHS England (2025) Changes to the GP Contract in 2025\/26. accessed. https:\/\/www.england.nhs.uk\/long-read\/changes-to-the-gp-contract-in-2025-26. 18 Dec 2025."},{"issue":"3","key":"2026020809154978000_76.763.e116.58","doi-asserted-by":"crossref","first-page":"e668","DOI":"10.1111\/hsc.13437","article-title":"Specialist nursing case management support for carers of people with dementia: a qualitative study comparing experiences of carers with and without Admiral nursing","volume":"30","author":"Gridley","year":"2022","journal-title":"Health Soc Care Community"},{"issue":"4","key":"2026020809154978000_76.763.e116.59","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1002\/gps.5256","article-title":"How do Admiral nurses and care home staff help people living with dementia and their family carers prepare for end-of-life?","volume":"35","author":"Moore","year":"2020","journal-title":"Int J Geriatr Psychiatry"}],"container-title":["British Journal of General Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.3399\/BJGP.2025.0218","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,8]],"date-time":"2026-02-08T17:16:02Z","timestamp":1770570962000},"score":1,"resource":{"primary":{"URL":"http:\/\/bjgp.org\/lookup\/doi\/10.3399\/BJGP.2025.0218"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,24]]},"references-count":59,"journal-issue":{"issue":"763","published-online":{"date-parts":[[2026,1,30]]},"published-print":{"date-parts":[[2026,2,1]]}},"alternative-id":["10.3399\/BJGP.2025.0218"],"URL":"https:\/\/doi.org\/10.3399\/bjgp.2025.0218","relation":{},"ISSN":["0960-1643","1478-5242"],"issn-type":[{"value":"0960-1643","type":"print"},{"value":"1478-5242","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,24]]}}}