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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 doi: (Published 01 February 2017) Cite this as: BMJ 2017;356:j84

Rapid Response:

Continuity of care is in the patients´ favor – but who really cares?

We were delighted to read the paper by Barker et al assessing the association between continuity of care in general practice and hospital admissions (1). We have also read Barker´s research group´s paper assessing the effect of the national requirement on continuity of care for elderly patients in England (2).

We have studied with concern the decreasing trend in continuity of primary health care in Finland (3). According to our latest research patient-related continuity of care has decreased in all age-groups.

We are well aware of the differences in study designs between our own and Barker´s RGs. We also recognize the strengths and weaknesses of our studies. Nevertheless we appreciate the wisdom and courage of the English authorities and research to strengthen the continuity of primary health care and to initiate the evaluation of the effects of national requirements.

At the moment Finland is embarking on one of the most extensive social and health care reforms in its history. The coming reform has recently been pre-reviewed by an international panel organized by the European Observatory on Health Systems and Policies (4). According to the report, a monitor and evaluation strategy with pre-specified goals should be set up in the early state of the reform. In this valuable report we have not however seen a word on continuity of care.

The benefits of the continuity of primary health care for patients are well recognized and manifest, as also for the health care system (5-8). The question remains: who is responsible for putting this into practice and evaluating the outcome? Who will make sure that continuity of care is ensured at least for those patients who are both in need of it and benefit most? We believe that GPs and researchers should be more involved in this discussion and give recommendations together with policy-makers.

In England the right steps have already been taken to strengthen continuity of care (1, 2). We are not fully aware of the trend in continuity of primary health care in other European countries, but we suggest that, as an essential quality indicator, assessment of continuity of care should be taken as a national goal. As a means of enhancing the cohesiveness of primary welfare and medical facilities, efforts should be made to ensure that those most in need of them have access to a personally named accountable GP.

1. Barker I, Steventon A, Deeny S.R. 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 doi:
2. Barker I, Lloyd T, Steventon A. Effect of a national requirement to introduce named accountable general practitioners for patients aged 75 or older in England: regression discontinuity analysis of general practice utilisation and continuity of care. BMJ Open. 2016 Sep 16;6(9):e011422. doi: 10.1136/bmjopen-2016-011422.
3. Raivio R, Holmberg-Marttila D, Mattila KJ. (2014). Patients’ assessments of the continuity of primary care in Finland: a 15-year follow-up. Br J Gen Pract. 64(627):e657-63. doi: 10.3399/bjgp14X68184.
4. Couffinhal A, Cylus J, Elovainio R, Figueras J, Jeurissen P, McKee M, Smith P, Thomson S, Winblad U. International expert panel pre-review of health and social care reform in Finland. Reports and Memorandums of the Ministry of Social Affairs and Health 2016:66.
5. Kringos DS, Boerma WG, Hutchinson A, van der Zee J Groenewegen PP. The breadth of primary care: a systematic literature review of its core dimensions. BMC Health Serv Res 2010; 10: 65.
6. Freeman, G., & Hughes, J. (2010). Continuity of care and the patient experience. (Research paper). London, England: The King´s Fund. (An Inquiry into the Quality of General Practice in England)
7. Roland, M., Paddison, C.A.M. Better management of patients with multimorbidity. BMJ 2013;346:f2510 doi:
8. Haggerty JL, Reid, JR, Freeman, GK, Starfield BH, Adair CE, McKendry R: Continuity of care: a multidisciplinary review. BMJ 2003 3271219–1221.

Competing interests: No competing interests

09 February 2017
Risto J Raivio
Chief Physician, GP
Kari J. Mattila, Professor Emeritus; School of Medicine, University of Tampere, Finland
Joint Authority for Päijät-Häme Social and Health Care, Primary Health Care Unit
Keskussairaalankatu 7, 15850 Lahti, Finland