Continuity of care is more than just a catchphrase

The practice I work for recently took over another practice. As is not uncommon in acquisitions, this caused a temporary increase in staff turnover, including GPs.

The response from patients was interesting: just about every other patient asked if I was going to stay. And most patients – not just those with chronic or complex health conditions – expressed their dissatisfaction with the lack of continuity of care.

I’m sure that many colleagues can recall similar anecdotes. This seems to indicate that our patients value personal and longitudinal primary care. Yet, we are seeing many proposals, trials and projects at the moment that threaten this model, and will create fragmented care.

Two examples

For example, Queensland Health is running several trials at the moment that bypass the usual GP, including a hospital-avoidance project where the ambulance service brings patients to selected GP clinics that receive state funding.

However, usual practices do not receive funding or support to increase capacity to manage these extra presentations. Although projects like the one in Queensland may reduce visits to the ED, they don’t support a stable and enduring relationship between GPs and patients.

In another Queensland Health project, pharmacies are being encouraged to administer MMR vaccinations. That vaccinations in general practice are an opportunity for screening and prevention does not seem important to policy-makers.

In primary care literature, ‘continuity’ is often described as the relationship between a practitioner and a patient that extends beyond specific episodes of illness or disease. Unfortunately, other terms are often used synonymously, such as ‘care co-ordination’, ‘integration’, ‘care planning’, ‘case management’ and ‘discharge planning’.

The experience of continuity may be different for the patient and the health practitioner, adding to more misunderstandings.

According to a 2003 BMJ article by Haggerty et al, there are three types of continuity of care: informational continuity, management continuity and relational continuity. Of course, continuity is more than just sending a message to another health practitioner, or uploading a piece of information to an e-health database.

What is continuity of care?

Understanding individual patients’ preferences, values, background and circumstances cannot always be captured in health records. Practitioners who have longstanding relationships with their patients often know this information.

The RACGP describes continuity of care as “the situation where patients experience an episode of care as complete, or consistent, or seamless even if it is provided in a number of different consultations by different providers”.

There is abundant evidence that continuity in primary care results in improved patient health outcomes and satisfaction, and reduced costs. For example, relational continuity reduces both elective and emergency admissions. In other words, the rate of hospital admissions drops when people have their own GP.

Better aligned funding that supports primary care practitioners to provide long-term quality care is much needed at the moment.

Team care

A sustainable health system should free up GP teams and other health practitioners to deliver clinical co-ordination and integration of care across disciplines, especially for people living with complex and chronic health conditions.

Avoiding hospital admissions and increasing immunisation rates are laudable objectives, but it’s not a good idea to do this at the expense of continuity of care by the GP. If patients don’t have a GP they should be encouraged or assisted to find a doctor of their choice.

There is nothing wrong with new models of care as long as they don’t impact on the many benefits general practice has to offer.

This article was originally published in Australian Doctor Magazine.