Primary medical care continuity and patient mortality: a systematic review
Top Cited Papers
- 10 August 2020
- journal article
- review article
- Published by Royal College of General Practitioners in British Journal of General Practice
- Vol. 70 (698), e600-e611
- https://doi.org/10.3399/bjgp20x712289
Abstract
Background A 2018 review into continuity of care with doctors in primary and secondary care concluded that mortality rates are lower with higher continuity of care. Aim This association was studied further to elucidate its strength and how causative mechanisms may work, specifically in the field of primary medical care. Design and setting Systematic review of studies published in English or French from database and source inception to July 2019. Method Original empirical quantitative studies of any design were included, from MEDLINE, Embase, PsycINFO, OpenGrey, and the library catalogue of the New York Academy of Medicine for unpublished studies. Selected studies included patients who were seen wholly or mostly in primary care settings, and quantifiable measures of continuity and mortality. Results Thirteen quantitative studies were identified that included either cross-sectional or retrospective cohorts with variable periods of follow-up. Twelve of these measured the effect on all-cause mortality; a statistically significant protective effect of greater care continuity was found in nine, absent in two, and in one effects ranged from increased to decreased mortality depending on the continuity measure. The remaining study found a protective association for coronary heart disease mortality. Improved clinical responsibility, physician knowledge, and patient trust were suggested as causative mechanisms, although these were not investigated. Conclusion This review adds reduced mortality to the demonstrated benefits of there being better continuity in primary care for patients. Some patients may benefit more than others. Further studies should seek to elucidate mechanisms and those patients who are likely to benefit most. Despite mounting evidence of its broad benefit to patients, relationship continuity in primary care is in decline — decisive action is required from policymakers and practitioners to counter this.Keywords
This publication has 42 references indexed in Scilit:
- Modelling factors in primary care quality improvement: a cross-sectional study of premature CHD mortalityBMJ Open, 2013
- Relationship between Longitudinal Continuity of Primary Care and Likelihood of Death: Analysis of National Insurance DataPLOS ONE, 2013
- Impact of physician continuity on death or urgent readmission after discharge among patients with heart failureCMAJ : Canadian Medical Association Journal, 2013
- Association of Primary Care Characteristics with Variations in Mortality Rates in England: An Observational StudyPLOS ONE, 2012
- Does the organizational structure of health care systems influence care-seeking decisions? A qualitative analysis of Danish cancer patients' reflections on care-seekingScandinavian Journal of Primary Health Care, 2011
- Are the serious problems in cancer survival partly rooted in gatekeeper principles? An ecologic studyBritish Journal of General Practice, 2011
- Continuity of Care with a Primary Care Physician and Mortality in Older AdultsThe Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 2009
- What Patients Want From Primary Care Consultations: A Discrete Choice Experiment to Identify Patients' PrioritiesAnnals of Family Medicine, 2008
- Patients' views on interpersonal continuity in primary care: a sense of security based on four core foundationsFamily Practice, 2005
- Continuity of care: a multidisciplinary reviewBMJ, 2003