The Paradox of Primary Care

Measuring continuity of care: psychometric properties of the Nijmegen Continuity Questionnaire

“…This will be an important area for further research, given that poor continuity is suspected to have a negative impact on the health of people and populations and also increases medical errors. [1][2][3][4] Moreover, the NCQ can be used to compare continuity experiences for different diseases and multimorbidity patterns.…”

“…It has a positive impact on the health of people and populations and reduces medical errors. [1][2][3][4] Continuity of care is, nowadays, considered a multidimensional concept. [5][6][7][8] It comprises providers' knowledge of the patient as a person, the development of an ongoing relationship (personal continuity), and communication and collaboration between care providers to connect care.…”

Reforming primary care: innovation or destruction?

“…rather than disease-outcome (for example, blood pressure reduction) is measured, specialists and generalists achieve similar results -with generalists using fewer resources, 9,10 representing better value for money. 8,11 In line with this, stronger primary care is associated with better population health and life expectancy 12,13 and also better control of major chronic illness at lower cost.…”

“…Conversely, specialist care is recognised as being more expensive than generalist care, and there is a good deal of evidence to show that strong primary care is associated with better health outcomes at lower cost for the healthcare system overall. 6,7 This apparent contradiction has been described as the 'paradox of primary care' by Stange and Ferrer, 8 who also point out that optimum outcomes are generated when generalists and specialists collaborate. Unraveling the paradox depends on an appreciation of the limitations of relying on single-disease outcomes or costs to measure quality of care, and achieving a better understanding of the added value of 'integrating, prioritising, contextualising, and personalising' 8 health care across its many dimensions.…”

First do no harm: dropping in on members of the team, encouraging and thanking them

“…Primary care is the point of entry to the healthcare system for members of a family, community, geographical area, or list and provides care that is long-term, comprehensive, coordinated, and focused on people rather than on diseases. 3,4 Optimal management of individual diseases may require shared-care with specialists 3 but referring patients with functional problems undermines their self-efficacy, medicalises, disrupts the clinician's therapeutic relationship with them, 5 and risks diffusion or abnegation of responsibility through the 'collusion of anonymity'. 6 HARMING Allowing structure (of service) to impede process (of care).…”