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
The research by Barker et al. (2017) (1) is exceptionally important revealing a 12.5 % reduction in hospital admissions for ambulatory care conditions among older patients who received continuity of GP care.
Despite their claim, this is not the first such report as Menec et al (2006) (2) made the same finding for the same conditions in the same age group in Canada.
The importance lies in the size of the finding against a background, as they rightly state, of falling continuity in UK general practice. They found that 35.2% of NHS patients received good GP continuity and 30, 000 patients saw their GP every time, so answering decisively those alleging that continuity cannot be provided in modern general practice.
Moreover the benefits of continuity of care extend well beyond reducing hospital admissions and include, as Barker et al rightly state better patient satisfaction. Other benefits include better adherence to medical advice, better take-up of health promotion, and greater trust developed by patients in their doctors (3). A recent review of continuity of care (4) shows that it benefits GPs as well and also reduces costs for the NHS.
The mechanism is that continuity encourages more information sharing, more mutual understanding, empowers more trusting patients, so that better decisions are jointly taken. Substantial continuity generates a bespoke medical service.
The American Academy of Family Physicians rightly states that: “ continuity of care is the hallmark and objective of family medicine………” (5)
References
1. Barker I, Steenton A and Deeny S. 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 BMJ 2017 356:j4 doi:10.1136/mj.j84
2. Menec VH, Sirski M, Arrawar D and Katz A . Does continuity of care with a family physician reduce hospitalizations among older adults? J Health Serv Research Policy 2006; 11; No4:196-201.
3. Mainous AG, Baker R, Love M, Pereira Gray D and Gill JM. Continuity of Care and Trust in One’s Physician: Evidence From Primary Care in the United States and the United Kingdom Fam Med 2001;33:22-7
4. Pereira Gray D, Sidaway-Lee K, White E,Thorne A and Evans P. Improving continuity THE clinical challenge InnovAiT 2016 DOI: 10.1177/1755738016654504
5. American Academy of Family Physicians (2016) Continuity of care: definition of: http://www.aafp.otg/about/policies/all/definition-care.html
Rapid Response:
Continuity of care in general practice
The research by Barker et al. (2017) (1) is exceptionally important revealing a 12.5 % reduction in hospital admissions for ambulatory care conditions among older patients who received continuity of GP care.
Despite their claim, this is not the first such report as Menec et al (2006) (2) made the same finding for the same conditions in the same age group in Canada.
The importance lies in the size of the finding against a background, as they rightly state, of falling continuity in UK general practice. They found that 35.2% of NHS patients received good GP continuity and 30, 000 patients saw their GP every time, so answering decisively those alleging that continuity cannot be provided in modern general practice.
Moreover the benefits of continuity of care extend well beyond reducing hospital admissions and include, as Barker et al rightly state better patient satisfaction. Other benefits include better adherence to medical advice, better take-up of health promotion, and greater trust developed by patients in their doctors (3). A recent review of continuity of care (4) shows that it benefits GPs as well and also reduces costs for the NHS.
The mechanism is that continuity encourages more information sharing, more mutual understanding, empowers more trusting patients, so that better decisions are jointly taken. Substantial continuity generates a bespoke medical service.
The American Academy of Family Physicians rightly states that: “ continuity of care is the hallmark and objective of family medicine………” (5)
References
1. Barker I, Steenton A and Deeny S. 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 BMJ 2017 356:j4 doi:10.1136/mj.j84
2. Menec VH, Sirski M, Arrawar D and Katz A . Does continuity of care with a family physician reduce hospitalizations among older adults? J Health Serv Research Policy 2006; 11; No4:196-201.
3. Mainous AG, Baker R, Love M, Pereira Gray D and Gill JM. Continuity of Care and Trust in One’s Physician: Evidence From Primary Care in the United States and the United Kingdom Fam Med 2001;33:22-7
4. Pereira Gray D, Sidaway-Lee K, White E,Thorne A and Evans P. Improving continuity THE clinical challenge InnovAiT 2016 DOI: 10.1177/1755738016654504
5. American Academy of Family Physicians (2016) Continuity of care: definition of: http://www.aafp.otg/about/policies/all/definition-care.html
Competing interests: No competing interests