Relational continuity and patients’ perception of GP trust and respect: a qualitative study

Abstract

BackgroundDespite the benefits of relational continuity of care, particularly for patients with multimorbidity, the traditional model of continuity is changing. Revisiting what patients with ongoing problems want from relational continuity could encourage initiatives to achieve these within a modern healthcare system.AimTo examine the attributes of GPs that patients with long-term conditions value most, and which attributes patients believe are facilitated by relational continuity.Design and settingQualitative study in UK general practice.MethodA thematic analysis was carried out, based on secondary analysis of interviews with 25 patients with long-term conditions that were originally conducted to inform a patient-reported outcome measure for primary care.ResultsPatients with long-term conditions wanted their GPs to be clinically competent, to examine, listen to, care for, and take time with them, irrespective of whether they have seen them before. They believed that relational continuity facilitates a GP knowing their history, giving consistent advice, taking responsibility and action, and trusting and respecting them. Patients acknowledged practical difficulties and safety issues in achieving the first three of these without relational continuity. However, patients felt that GPs should trust and respect them even when continuity was not possible.ConclusionPolicy initiatives promoting continuity with a GP or healthcare team should continue. Many patients see continuity as a safety issue. When patients experience relationship discontinuity, they often feel that they are not taken seriously or believed by their GP. GPs should therefore consistently seek to visibly demonstrate trust in their patients, particularly when they have not seen them before.

Incidence, nature and causes of avoidable significant harm in primary care in England: retrospective case note review

“…Nevertheless, high levels of personal continuity may not always be best for patients. A recent qualitative study showed a mixed picture in terms of patients' perceptions of whether personal continuity improved safety, or not, 38 while a crosssectional ecological study found that general practices that appeared to have high levels of personal continuity did fewer urgent referrals 39 ; this does not necessary mean they were less safe, but it is a potential cause for concern.…”

General Practice in the Time of COVID-19: A Mixed-Methods Service Evaluation of a Primary Care COVID-19 Service

“…Given the success of the service as an educational tool, there may be a role for a future model to be more focused on empowering GPs by offering a telephone advice line allowing a collaborative approach to patient management. Future primary care COVID-19 services should focus on enabling GPs to review their own patients, which is well recognised as the safest model of care, by providing training in remote assessment and IPC supported by telephone and video triage [ 40 , 41 ]. This will free up COVID-19 service capacity to review and see patients presenting with COVID-19 symptoms who need face-to-face assessment in situations when their usual GP is currently unable to manage them, either due to workforce shortages, a lack of adequately trained staff, or a lack of PPE.…”

Trygghet uten særomsorg?

“…Helsepolitiske føringer, forskning og samenes eget organ er samstemte i at helsevesenet ikke er nok tilpasset samisk kulturforståelse (Hamran & Blix, 2018;Helsedirektoratet, 2013;Meld. St. 9 (2019-2020; Sametinget, 2011). Sametinget (2011) hevder at hjelpeapparatet overser at tjenesten er bygd opp mot norsk kultur og språk, og dermed møter alle brukere ut fra en likhetstanke som tar utgangspunkt i majoritetsbefolkningens ståsted.…”

“…For helsepersonellet kan mangel på relasjonell kontinuitet, det vil si svekket sammenheng i interaksjonen/forholdet mellom bruker og helsepersonell (Haggerty et al, 2003), til en viss grad kompenseres for ved utveksling av relevant informasjon om brukeren mellom helsepersonell (informativ kontinuitet) og at tjenesten har nødvendige rammer, struktur og at helsehjelpen kan planlegges og koordineres (organisatorisk kontinuitet). Men for brukeren vil mangel på relasjonell kontinuitet like fullt kunne skape utrygghet (Murphy & Salisbury, 2020).…”

“…Et viktig helsepolitisk mål er at alle skal ha tilgang til likeverdige, trygge og sikre helsetjenester (Meld. St. 9 (2019-2020). Trygge og sikre helsetjenester inngår i pasientsikkerhetsbegrepet og defineres som « … vern mot unødig skade som følge av helse-og omsorgstjenestens ytelser eller mangel på ytelser» (Helsedirektoratet, 2019, s. 31).…”