Primary Care Continuity Affects Outcomes in Youth With Mental Illness

Young Man Tired of Waiting in Hospital Waiting Room.
Patients with mental illness who received discontinuous or no primary care between age 17 and 18 had an increased rate of mental health-related hospitalization in young adulthood.

During the transition from pediatric to adult mental health care, adolescents and young adults with severe mental illness who receive fragmented or no primary care experience increased mental health admissions and emergency department visits, according to Canadian study results published in JAMA Network Open.

Alene Toulany, MD, MSc, of the Division of Adolescent Medicine, Hospital for Sick Children, Toronto, Ontario, Canada, and colleagues conducted a population-based cohort study using linked health and demographic administrative data for all adolescents aged 12 to 16 years with severe mental illness between 2002 and 2014 in Ontario. They followed patients through March 31, 2017. The investigators considered the degree of primary care continuity that a patient had during the transition period (age 17 to 18 years): continuous (always or sometimes with the same primary care physician as at baseline), discontinuous (primary care visits during the transition with a physician who was not the patient’s usual physician), and no primary care during the transition period. The main outcomes were mental health-related hospitalizations and emergency department visits in young adulthood (age 19 to 26 years).

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Of the 8409 adolescents with severe mental illness included in the study (68.0% female; mean age, 14.8 years), 65.1% had continuous primary care, 28.4% had discontinuous primary care, and 6.4% had no primary care during the transition period. Risk factors for no primary care included male gender (57.2%), lower socioeconomic status (31.5%), and the lack of a usual primary care provider at baseline (25.6%). Patients with discontinuous care or no primary care had an increased rate of mental illness-related hospitalization in young adulthood — adjusted relative rate 1.20 and 1.30, respectively — compared with patients who had continuous care.

The researchers noted several study limitations, including the inclusion of patients with only the most severe forms of mental illness and the failure to capture data from psychologists, social workers, nurses, and other therapists.

“Timely and appropriate access to effective primary care during this period may help improve long-term outcomes and should be the focus of more research and policy making,” researchers concluded.


Toulany A, Stukel TA, Kurdyak P, Fu L, Guttmann A. Association of primary care continuity with outcomes following transition to adult care for adolescents with severe mental illness. JAMA Netw Open. 2019;2(8):e198415.