Relationship continuity: when and why do primary care patients think it is safer?

Abstract

BackgroundDoctor-patient continuity is popular with patients and practitioners, and is associated with better outcomes; however, changes in policy and practice organisation have diminished its scope. Although there has been some discussion of safety implications from professionals' perspective, patients' views remain largely unexplored. AimTo explore patients' understanding of safety in primary care. Design and settingAn interview-based study with patients from general practices in the northwest of England. MethodPatients were recruited from five general practices through patient participation groups and posters in waiting rooms, with further participants recruited through snowballing techniques until no new themes emerged. In-depth interviews were digitally recorded and transcribed. Anonymised transcripts were coded and analysed inductively. Emergent themes were discussed by the team. ResultsFor patients, relationship continuity was not simply a matter of service quality but an important safety concern that offered greater psychosocial security than consultations with unfamiliar GPs. Relationship continuity enabled the GP to become a repository of information; acquire specialist knowledge of a patient's condition; become familiar with the patient's consulting behaviour; provide holistic care; and foster the development of trust. Patients were also aware of the risks: a false sense of security and lack of a fresh perspective. Their desire for continuity varied with the nature of their concerns, psychological vulnerability, and perception of GPs' qualities and skills. No one supported a return to imposed continuity. ConclusionRelationship continuity and choice of GP were important safety strategies, neither of which is adequately supported by recent policy changes.

Meeting the mental health needs of people with multiple sclerosis: a qualitative study of patients and professionals

“…A central clinical implication is therefore to preserve these continuous professional-patient relationships, with potential implications for psychological patient safety. [43] Our findings suggest professionals to have well-defined roles in which they feel confident and competent, suggesting additional training to broaden their remit would not be perceived as feasible. More integrated models of care, with joint working between primary care, specialist MS services and mental health services may help ensure appropriate access to services and support for both patients and professionals.…”

Sensemaking and the co‐production of safety: a qualitative study of primary medical care patients

“…Obviously I never saw him again. (F.31) Seeking continuity with a familiar and trusted GP was also a common strategy which is reported in detail elsewhere (Rhodes et al 2014). For example, one respondent talked about the difficulties of managing to get an appointment with a doctor who they had already con-sulted with, and with whom they wanted a further consultation.…”

The patient, the doctor, and the patient’s loyalty: a qualitative study in French general practice

“…Most studies on continuity of care, however, were carried out in countries in which the choice is subject to stricter rules and is more restrictive. 4,5,17,18 Previously, it has been reported that trust encourages loyalty. [13][14] In the present study, this appeared essential to creating and maintaining loyalty.…”

“…The topics addressed were chosen based on data from the literature and test interviews. 2,[4][5][6]9,[13][14][15] About 15 topics were selected (Boxes 1 and 2).Interviews were conducted between March and July 2015 and the interviews were carried out until data sufficiency was confirmed.…”

“…2,3 The maintenance of the relationship over time may be influenced by the concerns and psychological vulnerability of the patients, as well as their perception of the qualities of their GP. 2,[4][5][6] This relationship has an impact on how the patient is taken care of and on the quality of the treatment. It develops gradually and is linked to the concept of loyalty.…”