General practice and patient characteristics associated with personal continuity: a mixed-methods study

Winkel, Marije T. te; Slottje, Pauline; Kruif, Anja de; Lissenberg‐Witte, Birgit I.; Marum, Rob J. van; Schers, Henk; Uijen, Annemarie; Bont, Jettie; Maarsingh, Otto R

doi:10.3399/bjgp.2022.0038

Cited by 8 publications

(7 citation statements)

References 41 publications

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“…Participants expressed the need for a long-term trust relationship with the involved care professionals, and continuity is therefore deemed valuable for this vulnerable patient group. Consequently, the practice organisation should aim at optimal continuity of care provided by the same person [ 36 ]. This requires extra time and effort for the GP, which is not always feasible in daily practice.…”

Section: Discussionmentioning

confidence: 99%

Primary mental healthcare for adults with mild intellectual disabilities: Patients’ perspectives

Pouls,

Mastebroek,

Ligthart

et al. 2024

European Journal of General Practice

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Background People with mild intellectual disabilities (MID) experience more mental health (MH) problems than the general population but often do not receive appropriate primary MH care. Primary MH care is essential in integrative MH care and, therefore, demands high quality. To improve primary MH care for this patient group, account must be taken of the experiences of people with MID. So far, their perspectives have been largely absent from primary MH care research. Objectives To explore patients’ experiences, needs, and suggestions for improvement regarding primary MH care for people with MID. Methods Qualitative study among adults with MID who visited their GP with MH problems in the previous 12 months. Semi-structured interviews were conducted using a guide based on Person-Centred Primary Care Measures. Transcripts were analysed thematically. Results The 11 interviews that we conducted revealed four themes. The first theme, cumulative vulnerability, describes the vulnerability – instigated by the MID and reinforced by MH problems – experienced on a GP visit. The other themes (needs regarding the GP, needs regarding the network, self-determination) arise from this vulnerability. Conclusion People with both MID and MH problems are extra vulnerable in primary care but desire self-determination regarding their MH care trajectory. This requires investment in a good GP-patient relationship and the organisation of additional support to meet these patients’ needs, for which collaborative care with the patient, the patient’s network, and other (care) professionals is of utmost importance.

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Section: Discussionmentioning

confidence: 99%

Primary mental healthcare for adults with mild intellectual disabilities: Patients’ perspectives

Pouls,

Mastebroek,

Ligthart

et al. 2024

European Journal of General Practice

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“…Secondly, on the GP-practice organisational level, two aspects will contribute to a good, sustainable doctor-patient relationship: (1) optimal continuity in care provided in the practice by the same person 19 ; (2) registering the MID and additional communication needs in the patient's file. This can act as a reminder for the practitioner's assistant to schedule extra time for a consultation, thus allowing the practitioner to give sufficient attention and time to the patient during consultations and adapt the level of communication to the MID.…”

Section: Implications For Research and Practicementioning

confidence: 99%

Primary mental healthcare for adults with mild intellectual disabilities: care professionals’ perspectives

Pouls,

Mastebroek,

Ligthart

et al. 2024

BJGP Open

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BackgroundGeneral practitioners (GPs) and mental health nurse practitioners (MHNPs) often feel ill equipped to provide mental health (MH) care to people with mild intellectual disabilities (MID). This is worrying, as insufficient primary MH care may lead to more severe or chronic problems. To improve primary MH care for this patient group, account must be taken of the experiences and needs of GPs and MHNPs providing the care.AimTo explore GPs’ and MHNPs’ experiences, needs, and recommendations for improvement regarding primary MH care for adults with MID.Design & settingFocus group study among GPs and MHNPs.MethodFocus groups, guided by topics based on an interview study with adults with MID receiving primary MH care. Transcripts were analysed by thematic analysis.ResultsFour focus groups, with 19 GPs and 9 MHNPs, revealed four themes describing the needs and perceived complexity involved in providing MH care to patients with both MID and MH problems: 1] GPs’ and MHNPs’ struggles with adapting to challenging patient characteristics; 2] importance and difficulties of establishing a good doctor–patient relationship; 3] facilitating and hampering roles of the patient’s network; 4] GPs’ and MHNPs’ challenges to provide care in the healthcare chain.ConclusionGPs and MHNPs often experience providing care and support to this patient group as burdensome. It is important to consider the MID throughout the MH trajectory, to invest in a strong doctor–patient relationship, and to establish a stable, sustainable network and coordinated collaborative care around the patient.

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“… 6 , 8 , 9 Despite this, continuity is declining in many countries, 10 – 12 and structural changes in healthcare systems, prioritising quick access to any GP, and increasing GP workload are discussed as common reasons. 13 , 14 A system with GP personal lists might be one of the measures considered to prevent declining personal continuity, defined as a therapeutic relationship between a patient and a GP over time. 15 A named GP is also a home for patients’ medical history, and thus tracks and helps to coordinate patient care.…”

Section: Introductionmentioning

confidence: 99%

“…There is a wide perception that continuity of care (CoC) in general practice is linked to increased use of preventive care (1), better medication adherence (2,3), reduced polypharmacy (4), lower utilization of healthcare (5), fewer acute hospital admissions (6,7), and lower mortality (6,8,9). Despite that, continuity is declining in many countries (10)(11)(12), and structural changes in healthcare systems, quick access, and increasing general practitioner (GP) workload are discussed as common reasons (13,14). A system with GP personal lists might be one of the measures considered to prevent the falling personal continuity, defined as a therapeutic relationship between a patient and a GP over time (15).…”

Section: Introductionmentioning

confidence: 99%

Continuity and breaches in GP care and their associations with mortality for patients with chronic disease: an observational study using Norwegian registry data

Pahlavanyali,

Hetlevik,

Baste

et al. 2023

Br J Gen Pract

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Background: Despite many benefits of continuity of care with a named regular general practitioner (RGP), continuity is deteriorating in many countries. Aim: To investigate the association between RGP continuity and mortality, in addition to examine how breaches in continuity affect this association for patients with chronic diseases. Design and setting: Registry-based observational study using Norwegian primary care consultation data for patients with asthma, chronic obstructive pulmonary disease (COPD), diabetes mellitus, or heart failure. Method: Usual Provider of Care index (UPC, value 0-1) was used to measure both disease-related (UPCdisease) and overall (UPCall) continuity with the RGP at the time of consultation. In most analyses, patients who changed RGP during study period were excluded. In the combined group of all four chronic conditions, proportion of consultations with other GPs and out-of-hours services was calculated. Cox regression models calculated associations between continuity during 2013-2016 and mortality in 2017-2018. Results: COPD patients with UPCdisease <0.25 had 47% increased risk of dying within two years (HR 1.47 (95% CI 1.22-1.64)) compared with those with UPCdisease ≥ 0.75. Mortality also increased with decreasing UPCdisease for patients with heart failure and decreasing UPCall for those with diabetes. In the combined group of chronic conditions, mortality increased by decreasing UPCall. This latter association was found also for patients who had changed RGP. Conclusion: Higher disease- and overall RGP continuity are both associated with lower mortality. However, changing RGP did not significantly affect mortality, indicating a compensatory benefit of informational and management continuity in a patient list system.

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General practice and patient characteristics associated with personal continuity: a mixed-methods study

Cited by 8 publications

References 41 publications

Primary mental healthcare for adults with mild intellectual disabilities: Patients’ perspectives

Primary mental healthcare for adults with mild intellectual disabilities: Patients’ perspectives

Primary mental healthcare for adults with mild intellectual disabilities: care professionals’ perspectives

Continuity and breaches in GP care and their associations with mortality for patients with chronic disease: an observational study using Norwegian registry data

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