Continuity in Primary Care is Linked to Mortality

Dawn O’Shea, August 12, 2020

A systematic review published in the British Journal of General Practice (BJGP) provides evidence of the links between reduced mortality rates and continuity of primary care.

In the primary-care focused study, authors from the University of Leicester, Imperial College London and McGill University in Montreal, examined 13 quantitative studies that included either cross-sectional or retrospective cohorts with variable periods of follow-up. Twelve of these measured the effect on all-cause mortality.

A statistically significant protective effect of greater care continuity was found in nine, absent in two and in one, effects ranged from increased to decreased mortality depending on the continuity measure. The remaining study found a protective association for coronary heart disease mortality.

Improved clinical responsibility, physician knowledge and patient trust were suggested as causative mechanisms, although these were not investigated.

In a second study published in the same issue of the BJGP, a thematic analysis was carried out based on secondary analysis of interviews with 25 patients with long-term conditions.

Patients said they believed that relational continuity facilitates a GP knowing their history, giving consistent advice, taking responsibility and action and trusting and respecting them.

Patients acknowledged practical difficulties and safety issues in achieving the first three of these without relational continuity.

However, they felt that GPs should trust and respect them even when continuity was not possible.

The studies provide further evidence of the benefit of continuity of care in the primary care setting.

Murphy M, Salisbury C. Relational continuity and patients’ perception of GP trust and respect: a qualitative study. Br J Gen Pract. 2020 Aug 11 [Epub ahead of print]. doi: 10.3399/bjgp20X712349.

Baker R, Freeman JK, Haggerty JL, Bankart MJ, Nockels KH. Primary medical care continuity and patient mortality: a systematic review. Br J Gen Pract. 2020 Aug 11 [Epub ahead of print]. doi: 10.3399/bjgp20X712289.  Abstract.

This article originally appeared on Univadis, part of the Medscape Professional Network.