EVIDENCE ON BENEFITS OF CONTINUITY

Our 2024 review on continuity of care can be read here.

You can also watch Sir Denis Pereira Gray talk about the benefits of continuity in Webinar 1 from the Health Foundation Project.

Continuity has been shown to have benefits for patients, doctors and health systems. We have created a summary of 12 important benefits with key references.

When they receive continuity of doctor care, patients:

Are more satisfied. (Baker and Streatfield 1995, Baker et al 2003, Adler et al 2010)
Are more likely to follow medical advice (Warren et al 2015, Chen et al 2013)
Are more likely to take up offers of personal preventive medicine. (O’Malley et al 1997, Christakis et al 2000)
Are more likely to have a good doctor patient relationship with their GP. (Mainous et al 2001, Ridd et al 2011)
Are more likely to receive good quality of care. (O’Connor et al 1998, Romano and Segal 2015, Delgado et al 2022)
Are less likely to need to go to A&E. (Brousseau et al 2004, van den Berg et al 2016)
Are less likely to need a hospital admission, particularly for ambulatory care sensitive conditions. (Barker et al 2017, Bankart et al 2011)
Are likely to live longer. (Sandvik et al 2022, Pereira Gray et al 2018)

These key features have many different research studies underpinning them and we have simply selected two or three for each for the sake of simplicity and to keep the number of references manageable.

The Evidence: Citations

BENEFITS FOR DOCTORS

There are also advantages for GPs of continuity of care:

Accumulated knowledge- with continuity, GPs gain more accumulated knowledge of their patients and use it for the patient’s benefit (Hjortdahl & Borchgrevink 1991, Hjortdahl 1992, Ridd et al 2011)
GP satisfaction- personal knowledge of the patient and the doctor–patient relationship and personal continuity enable GPs to provide ‘higher-quality care’ (Ridd et al 2006)
Better adherence/concordance with the doctor’s advice- patients are easier to work with when they disclose more information and when advice is followed. (Chen et al 2013, Warren et al 2015)
Efficiency in practice administration- general practices run more efficiently, when staff are clear about who is the responsible GP. With personal lists queries and test results can be transmitted quickly to the patient’s responsible doctor (Pereira Gray 1979)
Internal professional audits- personal list practices can conduct internal practice audits on the performance of doctors. These internal inter-doctor audits are highly educational, sustain quality improvement, with privacy for the clinicians if weaknesses are exposed. (Pereira Gray 1995)
Forgiveness- Patients forgive some practice errors within strong patient–doctor relationships (Lings et al 2003)
Reduced GP workload. The time to a patient's next visit was shown to be longer when they saw the GP they had seen most frequently over the previous two years. It was estimated that high levels of continuity could reduce consultation demand by over 5%. (Kajaria-Montag et al 2022)

The Evidence: Citations

GP benefits

BENEFITS FOR HEALTH SYSTEMS

Lower costs for health systems

Better prevention, better prescribing and reduced hospitalisations means lower costs for health systems. Continuity of care has been shown to be associated with lower overall healthcare costs ( Weiss and Blustein 1996, De Maeseneer 2003, Bazemore et al 2018, Bazemore et al 2023) as well as specific costs such as prescription costs.

There are also benefits to entire health systems, such as the NHS, from continuity of care. Some of these emerge from the benefits to patients and doctors.