Continuity of Care
- what is continuity of care?
- what are the roadblocks to continuity of care?
- is continuity of care a good thing?
- facilitating continuity of care
- researching continuity
- resources and references
What is Continuity of Care?
Continuity of care involves at least three components:
- information transfer
- collaboration between different providers (information or management continuity)
- ongoing relationship between a patient and health care provider
What are the Roadblocks to Continuity of Care?
Health care fragementation - silos, speciality clinics, etc prevent communication. Tailored servies, such as anticoagulation clinics or mammography units, are useful, but need to have communication.
Walk-in clinics are necessary but hurt continuity.
Physician shortages are devestating for continuity.
Is Continuity of Care a Good Thing?
An ongoing relationship allows the health care team and patient to get to know each other, acquire knowledge, and learn about each other's attitudes and values. Relationships build trust and judgement, allowing patients to ask advice.
The patient-doctor relationship is one of the four principles of family medicine.
This is especially true for patients with chronic diseases or comorbidities, where continuity needs to be a given. It is not as clear whether continuity is important for younger, healthier people.
dlp: I think it also depends on how much personal ownership people take of their health. Someone who knows what's going on may be better off skipping around than someone who doens't pay so much attention.
Most family doctors can give examples of how knowing their patients reduced emergency department visits or hospital admissions.
Satisfaction of both the health care team and patients also results.
Is it cost-effective? An important question...
Ionescu-Ittu et al, (2007) show decreased visits to the emergency department among elderly Quebecois who have increased continuity with their primary care doctor.
Facilitating Continuity
Incentives can help.
System structures, such as Ontario's Family Health Networks or Family Health Teams, can encourage collaboration.
Researching Continuity
While most people think continuity is a good thing, the age of evidence-based medicine strongly encourages us to research and prove the intuitive.
Continuity is perhaps most easily measured using relational continuity, or the proportion of visits with a usual physician out of the total number of primary care visits. (Ionescu-Ittu et al, 2007)
Resources and References
Burge F, Lawson B, and Johnston G. 2003. Family Physician Continuity of Care and ED use in End-of-Life Cancer Care. Med Care 411:992-1001.