Continuity of Care: Process or Outcome?

Christakis, Dimitri A.

doi:10.1370/afm.86

Cited by 45 publications

(23 citation statements)

References 18 publications

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“…6 Our fi nding that various continuity measures were not associated with compliance is surprising and contrary to the fi ndings of previous research. 25 We concur with Christakis 28 that continuity may operate differently in different populations and that relatively high levels of continuity and quality of care might combine to create a ceiling effect, concealing the impact of continuity evident in other subpopulations.…”

Section: Physician-patient Relationship and Medication Compliancesupporting

confidence: 59%

Physician-Patient Relationship and Medication Compliance: A Primary Care Investigation

Kerse

Buetow²,

Mainous³

et al. 2004

The Annals of Family Medicine

303

209

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PURPOSEWe assessed the relationship between 4 attributes of the physicianpatient relationship and medication compliance. METHODSWe conducted a waiting room survey of patients consulting 22 general practitioners in 14 randomly selected practices in Auckland, New Zealand (81% response rate). A total of 370 consecutive patients (75% response rate) completed survey instruments about 4 attributes of the physician-patient relationship. Continuity of care (assessed from use of a usual physician, length of continuity, and perceived importance of continuity) and trust in the physician were ascertained before the consultation. After the consultation the Patient Enablement Index measured the physician's ability to enable patients in self-care, and concordance between the patient and physician was measured by a 6-item inventory of perceived agreement about the presenting problem and management, were ascertained immediately after the consultation. Compliance with prescribed medication therapy was ascertained by telephone follow-up 4 days after the consultation.RESULTS Overall, 220 patients (61%) received a prescription, and 79% of these patients were taking the medication at follow-up. In a univariate analysis adjusted for clustering, only trust and physician-patient concordance were signifi cantly related to compliance. In analysis further adjusted for health and demographic factors, physician-patient concordance was independently related to compliance (odds ratio = 1.34, 95% confi dence interval, 1.04-1.72).CONCLUSIONS Primary care consultations with higher levels of patient-reported physician-patient concordance were associated with one-third greater medication compliance. An emphasis on understanding and facilitating agreement between physician and patient may benefi t outcomes in primary care.

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Section: Physician-patient Relationship and Medication Compliancesupporting

confidence: 59%

Physician-Patient Relationship and Medication Compliance: A Primary Care Investigation

Kerse

Buetow²,

Mainous³

et al. 2004

The Annals of Family Medicine

303

209

View full text Add to dashboard Cite

show abstract

“…Some of our selections may be justifi ed with reference to other measures, because items with similar content may be found in current patient satisfaction surveys. 21,22 Unlike these earlier measures, the ECC-DM is grounded in a conceptual model that identifi es experienced continuity of care as a construct of patient satisfaction, 28 and marks a shift in thinking away from the earlier view of continuity of care as a process-of-care measure. 29 Eight of the items referred to the concept of a "usual doctor or nurse."…”

Section: Limitations Of Studymentioning

confidence: 99%

“…This fi nding is consistent with systematic review evidence that case manager roles may enhance the delivery of care in chronic illness. 9 As a construct of patient satisfaction, continuity of care may be valued in itself, 28 and interventions that promote continuity are to be encouraged. Further research is required to fi nd out whether more-favorable experiences of continuity of care are associated with better treatment or improved treatment outcomes.…”

Section: Limitations Of Studymentioning

confidence: 99%

Measuring Continuity of Care in Diabetes Mellitus: An Experience-Based Measure

Gulliford¹,

Naithani²,

Morgan

2006

The Annals of Family Medicine

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PURPOSE Continuity is an important attribute of health care, but appropriate measures are not currently available. We developed an experience-based measure of continuity of care in type 2 diabetes.METHODS A 19-item measure of experienced continuity of care for diabetes mellitus (ECC-DM) was developed from qualitative patient interview data with 4 continuity subdomains: longitudinal, fl exible, relational, and team and crossboundary continuity. The measure was implemented in a survey of 193 patients with type 2 diabetes from 19 family practices. Associations of ECC-DM scores with clinician organizational characteristics were estimated.RESULTS Potential ECC-DM scores ranged from 0 to 100 with an observed mean of 62.1 (SD 16.0). The average inter-item correlation was 0.343 and Cronbach's α was 0.908. Factor analysis found 4 factors that were generally consistent with the proposed subdomains. Patients' mean scores varied signifi cantly between practices (P = .001), ranging from 46 to 78 at different family practices. Experienced continuity was lower for patients receiving only hospital clinic care than for those receiving some diabetes care from their family practice (difference 13.7; 95% confi dence interval [CI], 8.2-19.2; P <.001). Patients had higher ECC-DM scores if their family practice had a designated lead doctor for diabetes (difference 8.2; 95% CI, 2.7-13.6; P = .003). CONCLUSIONSThe results provide evidence for the reliability, construct validity, and criterion validity of the experienced continuity-of-care measure. The measure may be used in research and monitoring to evaluate patient-centered outcomes of diabetes care. Patients' experiences of continuity of care vary between health care organizations and are infl uenced by the organizational arrangements for care.

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“…9,10 These findings may in part be due to management of illness in a context of trust and respect between physician and patient. 11,12 Teaching students about longitudinal care, the complexity of chronic disease, and the importance of continuity can be challenging. Traditional clerkships are short, 4 to 6 weeks in duration, and therefore may not provide an environment in which students can experience meaningful continuity.…”

Section: Medical Student Educationmentioning

confidence: 99%

Medical Student Education

Lippa¹

2006

Ophthalmology

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Continuity of Care: Process or Outcome?

Cited by 45 publications

References 18 publications

Physician-Patient Relationship and Medication Compliance: A Primary Care Investigation

Physician-Patient Relationship and Medication Compliance: A Primary Care Investigation

Measuring Continuity of Care in Diabetes Mellitus: An Experience-Based Measure

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