Background on Australia's Ageing Population and Primary Care Challenges
Australia's population is ageing rapidly, with the number of people aged 65 and over projected to grow significantly in the coming decades. This demographic shift places increasing pressure on hospitals, aged care services, and the broader healthcare system. Most older Australians prefer to remain living independently at home for as long as possible, supported by home care services. However, frequent hospitalisations and emergency department presentations remain common challenges for this group, often driven by complex health needs, medication management issues, and fragmented care.
General practitioners (GPs) play a central role in primary care, providing ongoing management for chronic conditions, preventive services, and coordination with allied health professionals. The concept of continuity of care—where patients maintain a consistent relationship with the same GP or small team of providers—has long been recognised as a cornerstone of effective general practice. In Australia, bodies such as the Royal Australian College of General Practitioners (RACGP) emphasise its importance for building trust, improving health outcomes, and reducing unnecessary acute care utilisation.
The Landmark 2026 Study from Flinders University and SAHMRI
A major new study led by the Registry of Senior Australians (ROSA) Research Centre at the South Australian Health and Medical Research Institute (SAHMRI) in collaboration with Flinders University has provided robust evidence on the benefits of continuity of GP care. Published in the Journal of the American Geriatrics Society in April 2026, the research analysed health outcomes for more than 120,000 Australians aged 65 and over who were receiving long-term home care services between 2016 and 2019.
Led by Professor Gillian Caughey of Flinders University, the study examined the association between continuity of primary care, patterns of healthcare utilisation, and risks of mortality and hospitalisation. It also explored broader primary health care services, including nurse practitioner attendances, comprehensive medication reviews, health assessments, and allied health support.
This work builds on an earlier ROSA study involving over 330,000 residents in more than 3,000 aged care facilities, which found that only 17% of residents maintained continuity with their usual GP after entering care. Those who did experienced measurable reductions in adverse outcomes.
Key Findings on Reduced Hospital Risks
The results are striking. Older Australians who continued seeing their usual GP experienced an 18 to 28 per cent lower risk of emergency department presentations or hospital admissions compared with those who frequently saw new doctors. Specific reductions included lower risks of fall-related hospitalisations, weight loss and malnutrition-related admissions, and delirium or dementia-related hospitalisations.
Preventative and multidisciplinary patterns of care delivered the strongest outcomes. Individuals receiving longer GP consultations, care management plans, and coordinated allied health support—with less reliance on urgent or after-hours care—saw a 15 to 36 per cent lower risk of hospitalisation and reduced mortality rates. These patterns emphasise proactive disease management and prevention over reactive crisis response.
The study highlights how relational continuity allows GPs to develop deep knowledge of a patient's medical history, medications, preferences, and social context, enabling earlier intervention and better coordination across the care team.
Implications for Australian Health Policy and Funding
The findings underscore the urgent need for policy and funding reforms to support continuity of care in primary settings. Professor Caughey and colleagues call for incentives that prioritise long-term GP-patient relationships, particularly for older people with complex needs. This includes reforms to Medicare item structures, support for multidisciplinary teams, and measures to reduce barriers to comprehensive care planning.
Supported by the Medical Research Future Fund, the research provides evidence that can inform national strategies on aged care and primary health. It aligns with broader efforts by the Australian Government and bodies like the Aged Care Quality and Safety Commission to improve outcomes in home care and residential aged care.
Photo by Brett Jordan on Unsplash
Connections to Higher Education and Medical Training in Australia
This research originates from leading Australian universities and research institutes, including Flinders University, the University of South Australia (UniSA), and the University of Adelaide. It exemplifies the vital role of higher education institutions in generating evidence that shapes national health policy.
For academics and PhD-track researchers, the study highlights growing opportunities in health services research, geriatrics, and primary care. University programs in medicine, nursing, and allied health can integrate these findings into curricula, training future GPs and specialists to value and implement continuity of care. Flinders University's Caring Futures Institute and similar centres at other institutions are well-positioned to expand research training in this area.
The work also points to the need for increased investment in university-led studies on aged care, potentially creating more postdoctoral positions, research grants, and collaborative projects between universities, SAHMRI, and government agencies.
Stakeholder Perspectives: GPs, Patients, and Administrators
From the GP perspective, maintaining continuity requires adequate time and resources for complex consultations. The RACGP has welcomed the findings, noting they reinforce the value of relational care in general practice. Patients and their families report greater confidence and satisfaction when seeing a familiar provider who understands their full story.
University administrators and health faculty leaders see direct relevance to workforce planning. With Australia's GP shortage and increasing demand for aged care expertise, medical schools are under pressure to produce graduates skilled in longitudinal care. The research provides compelling data for advocating expanded placements in primary care settings and interdisciplinary training programs.
Challenges in Implementing Continuity of Care
Despite the clear benefits, several barriers persist. High GP workloads, workforce shortages in regional and remote areas, and funding models that favour episodic care over ongoing relationships can undermine continuity. In aged care settings, transitions between home care and residential care often disrupt established GP relationships.
Variation in service utilisation across facilities and regions also exists, with some older Australians having limited access to comprehensive preventive services. Addressing these challenges requires coordinated action across federal and state governments, primary health networks, and educational institutions.
Future Outlook and Opportunities for Academic Research
Looking ahead, this body of research opens avenues for further investigation into scalable interventions, digital tools to support continuity, and equity considerations for culturally and linguistically diverse older populations. Australian universities are uniquely placed to lead international collaborations on primary care models for ageing societies.
With the Medical Research Future Fund and other sources continuing to support such work, expect expanded PhD and early-career researcher opportunities in fields like health economics, implementation science, and gerontology. The findings also support advocacy for policy changes that could reshape how medical education prepares practitioners for an ageing Australia.
Actionable Insights for Academics and Institutions
University leaders can use these results to strengthen grant applications, curriculum development, and partnerships with health services. Researchers may consider projects examining the economic returns of continuity-focused care or evaluating training programs that embed relational continuity principles.
For job seekers in higher education, roles in health faculties, research centres like ROSA, and policy-focused institutes offer meaningful ways to contribute to evidence-based improvements in older Australians' health outcomes.
