Analysis

Continuity of care matters

BMJ 2008; 337 doi: 10.1136/bmj.a867 (Published 7 August 2008)
Cite this as: BMJ 2008;337:a867

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  1. Bruce Guthrie, professor1,
  2. John W Saultz, professor2,
  3. George K Freeman, visiting professor of general practice3,
  4. Jeannie L Haggerty, Canada research chair4
  1. 1Primary Care Medicine, University of Dundee, Tayside Centre for General Practice, Dundee DD2 4BF
  2. 2Department of Family Medicine, Oregon Health and Science University, Oregon, USA
  3. 3Community Health Sciences Division, St George’s, University of London, London
  4. 4Départements de Sciences de la Santé Communautaire et Médecine Familiale, Université de Sherbrooke, Québec, Canada
  1. Correspondence to: B Guthrie b.guthrie{at}dundee.ac.uk
  • Accepted 15 May 2008

The current focus on increasing access makes it more difficult for patients to see the same doctor. But Bruce Guthrie and colleagues argue that relationships between doctors and patients are central to good care

Continuity of care refers to how an individual’s health care is connected over time.1 Whether continuity matters therefore depends on how important such connections are. Continuity is often of little immediate concern to young healthy people consulting with minor, acute problems. However, current care cannot be isolated from past and future care for people with more serious or chronic problems, who are the heaviest users of the service. For these patients, there is general agreement that continuity matters across all three of its core dimensions—informational, management, and relationship continuity (box 1).1 2 But there is less agreement about which dimensions matter most, or the right relation between continuity and access. We argue that an effective healthcare organisation has to embody all dimensions of continuity, alongside good access and systematic care.

Box 1 Three types of continuity of care

Informational continuity—Formally recorded information is complemented by tacit knowledge of patient preferences, values, and context that is usually held in the memory of clinicians with whom the patient has an established relationship

Management continuity—Shared management plans or care protocols, and explicit responsibility for follow-up and coordination, provide a sense of predictability and security in future care for both patients and providers

Relationship continuity—Built on accumulated knowledge of patient preferences and circumstances that is rarely recorded in formal records and interpersonal trust based on experience of past care and positive expectations of future competence and care

Continuity in a changing world

All three types of continuity used to be embodied by a patient’s personal doctor: relationship continuity was assumed, informational continuity resided in this doctor’s memory and paper records, and management continuity flowed from the doctor working …

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