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

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 .