Continuity of care: why it matters and what we can do
Alexandra Hofer A C and Malcolm McDonald B
+ Author Affiliations
- Author Affiliations
A Torres and Cape Hospital and Health Service, 163 Douglas Street, Thursday Island, Qld 4875, Australia.
B Australian Institute for Tropical Health and Medicine, James Cook University, Cairns Campus, PO Box 6811, Cairns, Qld 4870, Australia.
C Corresponding author. Email: alexandra.hofer87@gmail.com
Australian Journal of Primary Health 25(3) 214-218 https://doi.org/10.1071/PY19041
Submitted: 9 February 2019 Accepted: 20 April 2019 Published: 14 June 2019
Abstract
Continuity of care matters; however, expansion and specialisation of the health system tends to fragment care. Continuity of care is accompanied by a range of patient benefits, including reduced all-cause mortality; lower rates of hospital presentation and preventable admission; and improved patient satisfaction. Potential concerns have been raised about some aspects of continuity of care, but these are outweighed by the perceived benefits. There are many barriers to achieving continuity, especially in rural and remote settings. Some practical solutions have been proposed that include adapting clinic procedures, utilising a small team approach, improving staff retention and ongoing advocacy.
References
Baker M, Jeffers H (2016) Continuity of care in modern day general practice. (Royal College of General Practitioners: London, UK) Available at http://www.rcgp.org.uk/policy/rcgp-policy-areas/continuity-of-care.aspx [Verified 9 November 2018]Barker I, Steventon A, Deeny SR (2017) Association between continuity of care in general practice and hospital admissions for ambulatory care sensitive conditions: cross sectional study of routinely collected, person level data. British Medical Journal 356, j84
| Association between continuity of care in general practice and hospital admissions for ambulatory care sensitive conditions: cross sectional study of routinely collected, person level data.Crossref | GoogleScholarGoogle Scholar | 28148478PubMed |
Bradford NK, Caffery LJ, Smith AC (2016) Telehealth services in rural and remote Australia: a systematic review of models of care and factors influencing success and sustainability. Rural and Remote Health 16, 3808
Broom DH (2003) Familiarity breeds neglect? Unanticipated benefits of discontinuous primary care. Family Practice 20, 503–507.
| Familiarity breeds neglect? Unanticipated benefits of discontinuous primary care.Crossref | GoogleScholarGoogle Scholar | 14507788PubMed |
Cabana MD, Jee SH (2004) Does continuity of care improve patient outcomes? The Journal of Family Practice 53, 974–980.
Chen C-C, Tseng C-H, Cheng S-H (2013) Continuity of care, medication adherence, and health care outcomes among patients with newly diagnosed type 2 diabetes: a longitudinal analysis. Medical Care 51, 231–237.
| Continuity of care, medication adherence, and health care outcomes among patients with newly diagnosed type 2 diabetes: a longitudinal analysis.Crossref | GoogleScholarGoogle Scholar | 23269110PubMed |
Chondur R, Li SQ, Guthridge S, Lawton P (2014) Does relative remoteness affect chronic disease outcomes? Geographic variation in chronic disease mortality in Australia, 2002 – 2006. Australian and New Zealand Journal of Public Health 38, 117–121.
| Does relative remoteness affect chronic disease outcomes? Geographic variation in chronic disease mortality in Australia, 2002 – 2006.Crossref | GoogleScholarGoogle Scholar | 24812715PubMed |
Doescher MP, Saver BG, Fiscella K, Franks P (2004) Preventive care: does continuity count? Journal of General Internal Medicine 19, 632–637.
| Preventive care: does continuity count?Crossref | GoogleScholarGoogle Scholar | 15209601PubMed |
Drivsholm T, Olivarius NdF (2006) General practitioners may diagnose type 2 diabetes mellitus at an early disease stage in patients they know well. Family Practice 23, 192–197.
| General practitioners may diagnose type 2 diabetes mellitus at an early disease stage in patients they know well.Crossref | GoogleScholarGoogle Scholar | 16449242PubMed |
Fan VS, Burman M, McDonell MB, Fihn SD (2005) Continuity of care and other determinants of patient satisfaction with primary care. Journal of General Internal Medicine 20, 226–233.
| Continuity of care and other determinants of patient satisfaction with primary care.Crossref | GoogleScholarGoogle Scholar | 15836525PubMed |
Freeman G, Hughes J (2010) Continuity of care and the patient experience: an inquiry into the quality of general practice in England. (The King’s Fund: London, England) Available at https://www.kingsfund.org.uk/sites/default/files/field/field_document/continuity-care-patient-experience-gp-inquiry-research-paper-mar11.pdf [Verified 4 November 2018]
Gill JM, Mainous AG, Nsereko M (2000) The effect of continuity of care on emergency department use. Archives of Family Medicine 9, 333–338.
| The effect of continuity of care on emergency department use.Crossref | GoogleScholarGoogle Scholar | 10776361PubMed |
Greysen SR, Detsky AS (2015) Understanding the value of continuity in the 21st Century. JAMA Internal Medicine 175, 1154–1156.
Haggerty JL, Reid RJ, Freeman GK, Starfield BH, Adair CE, McKendry R (2003) Continuity of care: a multidisciplinary review. British Medical Journal 327, 1219–1221.
| Continuity of care: a multidisciplinary review.Crossref | GoogleScholarGoogle Scholar | 14630762PubMed |
Hansen AH, Halvorsen PA, Aaraas IJ, Førde OH (2013) Continuity of GP care is related to reduced specialist healthcare use: a cross-sectional survey. The British Journal of General Practice 63, e482–9.
| Continuity of GP care is related to reduced specialist healthcare use: a cross-sectional survey.Crossref | GoogleScholarGoogle Scholar |
Hayman NE, White NE, Spurling GE (2009) Improving Indigenous patient’s access to mainstream health services: the Inala experience. The Medical Journal of Australia 190, 604–606.
Hill A, Freeman G (2011) Promoting continuity of care in general practice. (Royal College of General Practitioners: London, UK) Available at http://www.rcgp.org.uk/policy/rcgp-policy-areas/continuity-of-care.aspx [Verified 4 November 2018]
Homer CSE (2016) Models of maternity care: evidence for midwifery continuity of care. The Medical Journal of Australia 205, 370–374.
| Models of maternity care: evidence for midwifery continuity of care.Crossref | GoogleScholarGoogle Scholar |
Hunter E, Onnis LA, Santhanam-Martin R, Skalicky J, Gynther B, Dyer G (2013) Beasts of burden or organised cooperation: the story of a mental health team in remote, Indigenous Australia. Australasian Psychiatry 21, 572–577.
| Beasts of burden or organised cooperation: the story of a mental health team in remote, Indigenous Australia.Crossref | GoogleScholarGoogle Scholar | 23996667PubMed |
Hussey PS, Schneider EC, Rudin RS, Fox DS, Lai J, Pollack CE (2014) Continuity and the costs of care for chronic disease. JAMA Internal Medicine 174, 742–748.
Jackson C, Ball L (2018) Continuity of care: vital, but how do we measure and promote it? Australian Journal of General Practice 47, 662–664.
Jeffers H, Baker M (2016) Continuity of care: still important in modern-day general practice. The British Journal of General Practice 66, 396–397.
| Continuity of care: still important in modern-day general practice.Crossref | GoogleScholarGoogle Scholar | 27481958PubMed |
Leach B, Morgan P, Strand de Oliveira J, Hull S, Ostbye T, Everett C (2017) Primary care multidisciplinary teams in practice: a qualitative study. BMC Family Practice 18, 115
| Primary care multidisciplinary teams in practice: a qualitative study.Crossref | GoogleScholarGoogle Scholar | 29284409PubMed |
Medlin LG, Chang AB, Fong K, Jackson R, Bishop P, Dent A, Hill DC, Vincent S, O’Grady KA (2014) Indigenous Respiratory Outreach Care: the first 18 months of a specialist respiratory outreach service to rural and remote Indigenous communities in Queensland, Australia. Australian Health Review 38, 447–453.
| Indigenous Respiratory Outreach Care: the first 18 months of a specialist respiratory outreach service to rural and remote Indigenous communities in Queensland, Australia.Crossref | GoogleScholarGoogle Scholar | 25179506PubMed |
Murtagh J (1982) Strategies for continuing care in general practice. Australian Family Physician 11, 332–337.
Nutting PA, Goodwin MA, Flocke SA, Zyzanski SJ, Stange KC (2003) Continuity of primary care: to whom does it matter and when? Annals of Family Medicine 1, 149–155.
| Continuity of primary care: to whom does it matter and when?Crossref | GoogleScholarGoogle Scholar | 15043376PubMed |
Peiris D, Brown A, Howard M, Rickards BA, Tonkin A, Ring I, Hayman N, Cass A (2012) Building better systems of care for Aboriginal and Torres Strait Islander people: findings from the Kanyini health systems assessment. BMC Health Services Research 12, 369
| Building better systems of care for Aboriginal and Torres Strait Islander people: findings from the Kanyini health systems assessment.Crossref | GoogleScholarGoogle Scholar | 23102409PubMed |
Pereira Gray D, Sidaway-Lee K, White E, Thorne A, Evans P (2016) Improving continuity: the clinical challenge. InnovAiT 9, 635–645.
| Improving continuity: the clinical challenge.Crossref | GoogleScholarGoogle Scholar |
Pereira Gray DJ, Sidaway-Lee K, White E, Thorne A, Evans PH (2018) Continuity of care with doctors – a matter of life and death? A systematic review of continuity of care and mortality. BMJ Open 8, e021161
| Continuity of care with doctors – a matter of life and death? A systematic review of continuity of care and mortality.Crossref | GoogleScholarGoogle Scholar | 29959146PubMed |
Roland M (2012) Continuity of care: betrayed values or misplaced nostalgia? International Journal of Integrated Care 12, e200
| Continuity of care: betrayed values or misplaced nostalgia?Crossref | GoogleScholarGoogle Scholar | 23593056PubMed |
Royal College of General Practitioners (2013) Continuity of care toolkit. (Royal College of General Practitioners: London, UK) Available at http://www.rcgp.org.uk/-/media/Files/Policy/A-Z-policy/RCGP-Continuity-of-Care-Toolkit.ashx?la=en [Verified 4 November 2018]
Sans-Corrales M, Pujol-Ribera E, Gené-Badia J, Pasarín-Rua MI, Iglesias-Pérez B, Casajuana-Brunet J (2006) Family medicine attributes related to satisfaction, health and costs. Family Practice 23, 308–316.
| Family medicine attributes related to satisfaction, health and costs.Crossref | GoogleScholarGoogle Scholar | 16461452PubMed |
Saultz JW, Albedaiwi W (2004) Interpersonal continuity of care and patient satisfaction: a critical review. Annals of Family Medicine 2, 445–451.
| Interpersonal continuity of care and patient satisfaction: a critical review.Crossref | GoogleScholarGoogle Scholar | 15506579PubMed |
Sidaway-Lee K, Pereira Gray D, Evans P (2019) A method for measuring continuity of care in day-to-day general practice: a quantitative analysis of appointment data. British Journal of General Practice 69, e356–e362.
Sweeney A, Davies J, McLaren S, Whittock M, Lemma F, Belling R, Clement S, Burns T, Catty J, Rees Jones I, Rose D, Wykes T (2016) Defining continuity of care from the perspectives of mental health service users and professionals: an exploratory, comparative study. Health Expectations 19, 973–987.
| Defining continuity of care from the perspectives of mental health service users and professionals: an exploratory, comparative study.Crossref | GoogleScholarGoogle Scholar | 26714263PubMed |
Tarlier DS, Browne A, Johnson J (2007) The influence of geographical and social distance on nursing practice and continuity of care in a Remote First Nations Community. Canadian Journal of Nursing Research 39, 126–148.
Viscomi M, Larkins S, Sen Gupta T (2013) Recruitment and retention of general practitioners in rural Canada and Australia: a review of the literature. Canadian Journal of Rural Medicine 18, 13–23.
Wasson JH, Sauvign AE, Mogielnicki RP, Frey WG, Sox CH, Gaudette C, Rockwell A (1984) Continuity of outpatient medical care in elderly men: a randomised trial. Journal of the American Medical Association 252, 2413–2417.
| Continuity of outpatient medical care in elderly men: a randomised trial.Crossref | GoogleScholarGoogle Scholar | 6481927PubMed |
Wilkinson D, Ryan P, Hiller J (2001) Variation in mortality rates in Australia: correlation with Indigenous status, remoteness and socio-economic deprivation. Journal of Public Health Medicine 23, 74–77.
| Variation in mortality rates in Australia: correlation with Indigenous status, remoteness and socio-economic deprivation.Crossref | GoogleScholarGoogle Scholar | 11315700PubMed |
Wright M, Mainous AG (2018) Can continuity of care in primary care be sustained in the modern health system? Australian Journal of General Practice 47, 667–669.
