Patient–doctor continuity and diagnosis of cancer: electronic medical records study in general practice

Abstract

BackgroundContinuity of care may affect the diagnostic process in cancer but there is little research.AimTo estimate associations between patient–doctor continuity and time to diagnosis and referral of three common cancers.Design and settingRetrospective cohort study in general practices in England.MethodThis study used data from the General Practice Research Database for patients aged ≥40 years with a diagnosis of breast, colorectal, or lung cancer. Relevant cancer symptoms or signs were identified up to 12 months before diagnosis. Patient–doctor continuity (fraction-of-care index adjusted for number of consultations) was calculated up to 24 months before diagnosis. Time ratios (TRs) were estimated using accelerated failure time regression models.ResultsPatient–doctor continuity in the 24 months before diagnosis was associated with a slightly later diagnosis of colorectal (time ratio [TR] 1.01, 95% confidence interval [CI] =1.01 to 1.02) but not breast (TR = 1.00, 0.99 to 1.01) or lung cancer (TR = 1.00, 0.99 to 1.00). Secondary analyses suggested that for colorectal and lung cancer, continuity of doctor before the index consultation was associated with a later diagnosis but continuity after the index consultation was associated with an earlier diagnosis, with no such effects for breast cancer. For all three cancers, most of the delay to diagnosis occurred after referral.ConclusionAny effect for patient–doctor continuity appears to be small. Future studies should compare investigations, referrals, and diagnoses in patients with and without cancer who present with possible cancer symptoms or signs; and focus on ‘difficult to diagnose’ types of cancer.

Association between continuity of care in general practice and hospital admissions for ambulatory care sensitive conditions: cross sectional study of routinely collected, person level data

“…We did not examine the association between continuity of care and other forms of secondary care, community healthcare, or social care, and indeed there is some evidence that increased continuity of care may lead to later referral for cancer care. 31 This was a cross sectional, observational study. Although such studies can test for associations between characteristics, a common concern is that any association may be attributable to differences in unobserved confounders.…”

The expanding role of primary care in cancer control

“…121 However, the eff ect of doctorpatient continuity on time to diagnosis seems to be small (a maximum of 7 days for colorectal cancer) and not clinically important. 122 Finally, presumed life expectancy also aff ects diff erent steps in the diagnostic process, because PCPs take the benefi t of an early diagnosis into account in their decision for additional testing and referral for people who might be close to death.…”

Continuity of Primary Care and Emergency Hospital Admissions Among Older Patients in England

“…[5][6][7] Studies investigating the impact of continuity of care using individualpatient UK data for acute presentations are scarce, however. Salisbury et al 8 focused on multimorbidity and continuity of care, while Ridd et al 9 focused on continuity and diagnosis of cancer, but neither included acute care. Barker et al 10 found an association between higher continuity of care and fewer admissions for ambulatory care-sensitive conditions.…”