Continuity of care is the extent to which patients see the same doctor or other health care provider over time. Previous research has shown that if patients tend to see the same doctor they have better health and fewer emergency hospital admissions. Despite this, continuity of care in general practices is declining. In this research, we will learn how to improve continuity of care in general practice. To achieve this we have a number of objectives.
First, there are a number of different ways that practices can measure continuity. We will host two workshops, including patients, and general practitioners to develop a shared understanding of how to measure continuity of care in a way that suits their needs.
Second, we will analyse patient records from a large number of general practices to understand how much continuity is affected by: a) practices becoming larger, b) more doctors working part time, c) patients and doctors moving practice.
Third, we will study a sample of general practices with high continuity in detail. We will organise interviews with staff and patients, to find out how these practices have organised themselves in order to help support continuity of care.
Fourth, we will assess the extent to which practices with higher continuity have lower health service costs, lower hospital admissions, fewer consultations and less prescribing, particularly for patients with long-term conditions.
Fifth, we will host two workshops of doctors, researchers and patients, to draw up practical guidance for general practices that want to increase their continuity.
Relational continuity of care (RCC) is the extent to which patients see the same clinicians over time. It is linked to patient satisfaction and better health outcomes, especially for older and vulnerable patients. The overall aim of this project is to develop a deep understanding of how general practices can optimise RCC. We have five objectives.
First, there are different ways of measuring RCC, which reflect different conceptions of RCC between clinicians and patients. We will host consensus workshops of patients, primary care clinicians and researchers to develop a shared understanding of RCC and help practices determine how best to measure and monitor their own RCC.
Second, to understand the drivers of RCC, we will use patient level data from a large number of general practices to model the association between RCC and practice-level characteristics such as staff and patient turnover, part-time working, and practice size and funding per patient. We will then determine which general practices are in the highest decile of relational continuity of care given their characteristics.
Third, we will recruit and study in detail a sample of general practices from this decile. We will explore staff and patient experience of continuity and determine practice policies contributing to RCC, along with barriers and facilitators to their implementation.
Fourth, we will undertake economic analysis to estimate the effects of RCC on resource costs and health outcomes, using linked primary and secondary care data. This will help us understand the likely effects of changing RCC in a general practice and whether these effects vary in different patient groups.
Fifth, we will develop empirically-informed practical guidance to improve continuity of care, collating findings of our quantitative analysis of predictors of RCC, case studies, economic analysis, and existing work on continuity of care in the UK and internationally.
Various Relational Continuity of Care indices; primary care consultations; primary care prescribing; unplanned hospital admissions; A&E presentations; outpatient appointments; primary care costs; secondary care costs; mortality.
Tom Marshall - Chief Investigator - University of Birmingham
Panagiotis Kasteridis - Corresponding Applicant - University of Birmingham
Brian Willis - Collaborator - University of Birmingham
Iestyn Williams - Collaborator - University of Birmingham
Jinyang Chen - Collaborator - University of Birmingham
Krishnarajah Nirantharakumar - Collaborator - University of Birmingham
Sheila Greenfield - Collaborator - University of Birmingham
Zecharias Anteneh - Collaborator - University of Birmingham
Jinyang Chen - Collaborator - University of York
Zecharias Anteneh - Collaborator - University of York
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;CPRD Aurum Ethnicity Record;CPRD GOLD Ethnicity Record