Continuity of care: Vital, but how do we measure and promote it?

Jackson, Claire; Ball, Lauren

doi:10.31128/ajgp-05-18-4568

Cited by 20 publications

(22 citation statements)

References 14 publications

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“…For these reasons, alternative evidence-based quality assessment frameworks for complex patients have been proposed or are in development. These might measure and incentivise continuity of care [102], patient preferences and values [100], or use patient-reported indicators to capture the patient's care experience and outcomes [103].…”

Section: Discussionmentioning

confidence: 99%

General practitioner strategies for managing patients with multimorbidity: a systematic review and thematic synthesis of qualitative research

2020

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Background: General practitioners (GPs) increasingly manage patients with multimorbidity but report challenges in doing so. Patients describe poor experiences with health care systems that treat each of their health conditions separately, resulting in fragmented, uncoordinated care. For GPs to provide the patient-centred, coordinated care patients need and want, research agendas and health system structures and policies will need to adapt to address this epidemiologic transition. This systematic review seeks to understand if and how multimorbidity impacts on the work of GPs, the strategies they employ to manage challenges, and what they believe still needs addressing to ensure quality patient care. Methods: Systematic review and thematic synthesis of qualitative studies reporting GP experiences of managing patients with multimorbidity. The search included nine major databases, grey literature sources, Google and Google Scholar, a hand search of Journal of Comorbidity, and the reference lists of included studies. Results: Thirty-three studies from fourteen countries were included. Three major challenges were identified: practising without supportive evidence; working within a fragmented health care system whose policies and structures remain organised around single condition care and specialisation; and the clinical uncertainty associated with multimorbidity complexity and general practitioner perceptions of decisional risk. GPs revealed three approaches to mitigating these challenges: prioritising patient-centredness and relational continuity; relying on knowledge of patient preferences and unique circumstances to individualise care; and structuring the consultation to create a sense of time and minimise patient risk.

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Section: Discussionmentioning

confidence: 99%

General practitioner strategies for managing patients with multimorbidity: a systematic review and thematic synthesis of qualitative research

2020

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“…It is highlighted that care is a continuous process, where an individual may, at any given time, need to access more than one health system service, especially in aging populations that face the challenges of chronic diseases (40). Moreover, the continuity of care is more than only the connection between the different levels, but it also depends on the information flow regarding the assistance provided between the different services (40).…”

Section: Discussionmentioning

confidence: 99%

Palliative Care for the Elderly in the Healthcare System: A Scoping Review

et al. 2022

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Objective: To map the scientific evidence related to the organization of palliative care practices provided for the elderly in the Healthcare System. Materials and methods: This is a scoping review following the Joanna Briggs Institute’s method. The search was conducted in the PubMed, Cinahl, Web of Science, Scopus, VHL/Lilacs, Embase, and Cochrane databases, identifying 1,150 articles managed using the Endnote software. After the selection, the study sample consisted of 12 articles. The data were organized in Microsoft Excel spreadsheets, submitted to descriptive analysis, and discussed with the literature. Results: The relevance of palliative care practices for older adults to be organized in the Healthcare System was noted, focusing on primary healthcare, at home, and interdisciplinary coordination. However, there is still a fragmented offer of this care with limited considerations regarding the challenges and possibilities of its effectiveness. Conclusions: The mapping of scientific evidence on the subject shows that discussions regarding the insertion of palliative care in the Healthcare System are modest. The studies explore the role of primary care as the organizer of these practices, although in a fragmented perspective, with limited coordination between the Healthcare System services.

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“…8 Because utilisation indices for continuity can be calculated retrospectively on the basis of patient report or medical records, they can be applied relatively easily to any population or care setting. 9 Although these measures of longitudinality assess continuity only indirectly, they have nonetheless been consistently shown to correlate with positive clinical outcomes. 5…”

Section: Current Measures Of Continuitymentioning

confidence: 99%

Measuring continuity in the era of technology-enabled care

Bohnhoff¹,

Sekar²,

Pickering³

et al. 2022

Aust J Gen Pract

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CONTINUITY OF CARE (or simply, 'continuity'), which Haggerty et al define as the degree to which a patient experiences their care as 'coherent[, …] connected and consistent with [their] medical needs and personal context', has been recognised as a feature of high-quality medical care, especially primary care, for more than half a century. 1 Recent studies have reinforced this consensus, with data associating continuity with increased patient 2 and provider 3 satisfaction, decreased cost of care 4 and even decreased mortality. 5 However, measuring, tracking and improving continuity remains a significant challenge, in part because of the subjectivity and complexity of the patient-provider relationship. In addition, technological advancements in healthcare delivery may threaten the validity of existing measures of continuity. Here we review existing measures of patientexperienced continuity of care, discuss how they are affected by technologyrelated changes to healthcare and suggest avenues for future research on continuity.

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Continuity of care: Vital, but how do we measure and promote it?

Cited by 20 publications

References 14 publications

General practitioner strategies for managing patients with multimorbidity: a systematic review and thematic synthesis of qualitative research

General practitioner strategies for managing patients with multimorbidity: a systematic review and thematic synthesis of qualitative research

Palliative Care for the Elderly in the Healthcare System: A Scoping Review

Measuring continuity in the era of technology-enabled care

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