Continuity of care matters

Guthrie, Bruce; Saultz, John; Freeman, George; Haggerty, Jeannie

doi:10.1136/bmj.a867

Cited by 202 publications

(202 citation statements)

References 13 publications

(6 reference statements)

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“…Management continuity requires management from several providers who could otherwise work at cross purposes, especially important in complex or chronic diseases (Reid et al, 2002). Relational continuity builds on accumulated knowledge of patient preferences and circumstances that is rarely recorded in health records, and interpersonal trust based on experience of previous care and positive expectations of future competence and care (Guthrie et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

Women׳s views about maternity care: How do women conceptualise the process of continuity?

et al. 2015

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Section: Introductionmentioning

confidence: 99%

Women׳s views about maternity care: How do women conceptualise the process of continuity?

et al. 2015

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“…31 Relationship continuity with a trusted provider is seen to be a key attribute of high-performing primary care and is known to be important to patients and carers. 41,47,48 Moreover, good relationship continuity facilitates management and informational continuity. 41 Despite this, it is an aspect of care that has been relatively neglected in the literature.…”

Section: Relationship Continuitymentioning

confidence: 99%

“…41,47,48 Moreover, good relationship continuity facilitates management and informational continuity. 41 Despite this, it is an aspect of care that has been relatively neglected in the literature. 47 Implied in the concept of relationship continuity is the idea that the health-care provider involved knows the patient as a person first.…”

Section: Relationship Continuitymentioning

confidence: 99%

“…3 This leads to further fragmentation of care and reduced continuity. 41 Continuity of care is a complex multidimensional concept that can refer to relationships between patients and practitioners, co-ordination across services, information transfer and co-ordination of care over time, and the coherent delivery of services for people with long-term conditions. 31 Theories about continuity of care provide an appropriate framework for exploring the health-care experiences of PLWD and ensure that activities that support coproduction of care are identified and considered.…”

Section: Continuity Of Carementioning

confidence: 99%

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Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

Bunn

Burn

Goodman

et al. 2016

Health Serv Deliv Res

116

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BackgroundAmong people living with dementia (PLWD) there is a high prevalence of comorbid medical conditions but little is known about the effects of comorbidity on processes and quality of care and patient needs or how services are adapting to address the particular needs of this population.ObjectivesTo explore the impact of dementia on access to non-dementia services and identify ways of improving the integration of services for this population.DesignWe undertook a scoping review, cross-sectional analysis of a population cohort database, interviews with PLWD and comorbidity and their family carers and focus groups or interviews with health-care professionals (HCPs). We focused specifically on three conditions: diabetes, stroke and vision impairment (VI). The analysis was informed by theories of continuity of care and access to care.ParticipantsThe study included 28 community-dwelling PLWD with one of our target comorbidities, 33 family carers and 56 HCPs specialising in diabetes, stroke, VI or primary care.ResultsThe scoping review (n = 76 studies or reports) found a lack of continuity in health-care systems for PLWD and comorbidity, with little integration or communication between different teams and specialities. PLWD had poorer access to services than those without dementia. Analysis of a population cohort database found that 17% of PLWD had diabetes, 18% had had a stroke and 17% had some form of VI. There has been an increase in the use of unpaid care for PLWD and comorbidity over the last decade. Our qualitative data supported the findings of the scoping review: communication was often poor, with an absence of a standardised approach to sharing information about a person’s dementia and how it might affect the management of other conditions. Although HCPs acknowledged the vital role that family carers play in managing health-care conditions of PLWD and facilitating continuity and access to care, this recognition did not translate into their routine involvement in appointments or decision-making about their family member. Although we found examples of good practice, these tended to be about the behaviour of individual practitioners rather than system-based approaches; current systems may unintentionally block access to care for PLWD. Pathways and guidelines for our three target conditions do not address the possibility of a dementia diagnosis or provide decision-making support for practitioners trying to weigh up the risks and benefits of treatment for PLWD.ConclusionsSignificant numbers of PLWD have comorbid conditions such as stroke, diabetes and VI. The presence of dementia complicates the delivery of health and social care and magnifies the difficulties that people with long-term conditions experience. Key elements of good care for PLWD and comorbidity include having the PLWD and family carer at the centre, flexibility around processes and good communication which ensures that all services are aware when someone has a diagnosis of dementia. The impact of a diagnosis of dementia on pre-existing conditions should be incorporated into guidelines and care planning. Future work needs to focus on the development and evaluation of interventions to improve continuity of care and access to services for PLWD with comorbidity.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…1,4,5 General concepts of 'patient welcoming,' 'bonding' and 'quality of care' have been applied and used to evaluate the comprehensiveness approach. 1,2,5,6,7 It is important for the comprehensiveness element to be reinforced in the critical awareness of health professionals and the community to enable the realisation of transformative actions. 2,5 The importance of comprehensiveness for oral health outcomes involves strengthening community actions, developing personal skills and reorienting health services.…”

Section: Introductionmentioning

confidence: 99%

Perception of ‘Comprehensiveness of Care’: a qualitative study amongst dentists in the Brazilian Health System

et al. 2015

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Comprehensiveness relates both to the scope of services offered and to a holistic clinical approach. The aim of this study was to identify the perception of Brazilian dentists regarding key concepts of comprehensiveness and its importance in primary health care oral health services performed in the public sector. Focus groups were conducted to explore three main concepts, 'patient welcoming', 'bonding' and 'quality of care', as well as their aspects. In total, there were four focus groups comprising seven general dentists, all of whom had at least two years of experience in primary care, from municipalities of varying sizes. Discussions of approximately 60 minutes were conducted, audio-recorded and transcribed. The data were analysed by qualitative thematic analysis, in line with the framework approach. The general dentists reported that they are aware that in the Brazilian Health System, the onset of patient care by primary health care services must happen through 'patient welcoming.' Nevertheless, they suggested that this action is often performed poorly due to the large volume of patients. Although they knew the importance of 'bonding', they realised that there is a lack of education preparing professionals to address interpersonal and social issues. They were aware that 'quality of care' is related to multiple factors. Comprehensiveness, as an approach in dental public health practices, needs to be enhanced, and there is evidence that primary care dentists are aware of the need for such an approach.

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Continuity of care matters

Abstract: 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

Cited by 202 publications

References 13 publications

Women׳s views about maternity care: How do women conceptualise the process of continuity?

Women׳s views about maternity care: How do women conceptualise the process of continuity?

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

Perception of ‘Comprehensiveness of Care’: a qualitative study amongst dentists in the Brazilian Health System

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