Continuity in primary care

Relational continuity of care is based on the mutual relationship of trust and responsibility, as a result of repeated contacts between a patient and their physician, or other health care personnel. In primary care, relational continuity has been suggested as a mechanism for good quality of care.

Reading time approx. 8 minutes Published: November 7, 2022 Publication type:

SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

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Published: November 7, 2022 Report no: ut202219 Registration no: SBU 2022/206

Question

What systematic reviews are there on the effects of relational continuity in primary care?

Identified literature

Table 1. Systematic reviews with low/medium risk of bias
CHD = Coronary Heart Diesease; ED = Emergency Department; EHA = Emergency Hospital Admission; GP = General Practitioner
Included studies	Population/Intervention	Outcome and Results
Baker et al, 2020 [1] Primary medical care continuity and patient mortality: a systematic review
13 studies in quantitative synthesis Setting: 3 studies in US 3 studies in Canada 2 studies in England 1 study in Austria, France, Israel, South Korea, the Netherlands, respectively	Population: Patients seen wholly, or mostly, in primary care settings Intervention: Quantifiable measures of continuity of care	Mortality Selected populations (n=11) All cause (n=11): Significantly lower with higher continuity of care (n=9), no difference (n=1), statistics missing (n=1) Entire primary care population (n=2) All cause (n=1): No difference (n=1) CHD mortality (n=2): Significantly lower with higher continuity of care (n=1)
Authors' conclusion: “This review adds reduced mortality to the demonstrated benefits of there being better continuity in primary care for patients. Some patients may benefit more than others. Further studies should seek to elucidate mechanisms and those patients who are likely to benefit most.”
Huntley et al, 2014 [2] Which features of primary care affect unscheduled secondary care use? A systematic review
48 observational studies of which 8 studies reported on continuity of care Setting: 4 studied in US 3 studies in Canada 1 study in UK	Population: People of any age of either sex living in Organisation for Economic Cooperation and Development (OECD) countries with any health condition in a primary care setting Intervention: Factors and interventions at primary care practice level that impact on levels of utilisation of unscheduled secondary care. One factor of interest was measures of relational continuity.	Association with emergency department (ED) attendance (n=5): Fewer ED attendances with higher continuity of care (n=5) Association with emergency hospital admission (EHA) (n=4): Fewer EHAs with higher continuity of care (n=2) Fewer EHAs with greater ease to get appointment to regular GP (n=1) No association (n=1)
Authors' conclusion: “The majority of research was from different healthcare systems and limited in the extent to which it can inform policy. However, there is evidence that continuity of care is associated with reduced emergency department attendance and emergency hospital admissions.”

References

Baker R, Freeman GK, Haggerty JL, Bankart MJ, Nockels KH. Primary medical care continuity and patient mortality: a systematic review. Br J Gen Pract. 2020;70(698):e600-e11. Available from: https://doi.org/10.3399/bjgp20X712289.
Huntley A, Lasserson D, Wye L, Morris R, Checkland K, England H, et al. Which features of primary care affect unscheduled secondary care use? A systematic review. BMJ Open. 2014;4(5):e004746. Available from: https://doi.org/10.1136/bmjopen-2013-004746.

Literature search

Medline via OvidSP 7 July 2022

Title: Continuity of care in primary care
The final search result, usually found at the end of the documentation, forms the list of abstracts. .ab. = Abstract; .ab,ti. = Abstract or title; .af. = All fields; .bt. = Book title; exp = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; .fs. = Floating sub-heading, does not include terms found below this term in the MeSH hierarchy; .kf. = Author keyword; .sh. = Term from the Medline controlled vocabulary; .ti. = Title; .xs. = Floating sub-heading, includes terms found below this term in the MeSH hierarchy;/ = Term from the Medline controlled vocabulary, but does not include terms found below this term in the MeSH hierarchy; * = Focus (if found in front of a MeSH-term); * or $ = Truncation (if found at the end of a free text term); .mp. = Text, heading word, subject area node, title; " " = Citation Marks; searches for an exact phrase; adjn = Positional operator that lets you retrieve records that contain your terms (in any order) within a specified number (n) of words of each other; ? = replaces one or no letters; # = replaces one letter
Search terms		Items found
Population: Primary care⁴
1.	(family or physician$).af. or practice$.mp. or primary care.af. or exp Primary Health Care/ or primary.mp. or general pract$.af. or gp.tw. or gps.tw. [Pols sens]	4,665,062
Exposure: Relational continuity of care⁵
2.	"Continuity of Patient Care"/	20,393
3.	(continu* adj3 (physician* or practitioner* or doctor* or team* or provider* or nurs* or relation* or "cross-boundary*" or personal or interpersonal or care or healthcare)).ti,ab,kf.	39,607
4.	((discontinu* or fragment* or inconsisten*) adj3 (care or healthcare)).ti,ab,kf.	3,114
5.	(longitudinal* adj3 (care or healthcare)).ti,ab,kf.	1,537
6.	(("usual source" or "regular source") adj3 (care or healthcare)).ti,ab,kf.	1,384
7.	((usual* or regular* or stabil) adj3 (physician or practitioner* or doctor* or team* or provider* or nurs*)).ti,ab,kf.	6,961
8.	or/2-7	65,650
Study types: systematic reviews and meta-analyses
9.	Systematic Review.pt. OR Meta-Analysis.pt. OR Cochrane Database Syst Rev.ja. OR ((systematic adj4 review) OR "meta analys" OR metaanalys).ti,ab,bt.	396,893
Combined sets
10.	1 and 8 [population and exposure]	47,661
11.	*10 and 9 [Systematic reviews]*	*1,223*
Final result
12.	11	1,223

^4. Det känsliga sökfiltret från publikationen: Pols DH, Bramer WM, Bindels PJ, van de Laar FA, Bohnen AM. Development and Validation of Search Filters to Identify Articles on Family Medicine in Online Medical Databases. Ann Fam Med. 2015;13(4):364-6. Available from: https://doi.org/10.1370/afm.1780.

^5. Anpassat från publikationen: SBU. Kontinuitet i vården: En systematisk översikt och utvärdering av medicinska, hälsoekonomiska och etiska aspekter. Stockholm: Statens beredning för medicinsk och social utvärdering (SBU); 2021 329. [accessed July 8 2022]. Available from: https://www.sbu.se/329.

Scopus via Elsevier 8 July 2022

Title: Continuity of care in primary care
The final search result, usually found at the end of the documentation, forms the list of abstracts. TITLE-ABS-KEY = Title or abstract or keywords; ALL = All fields; PRE/n = "precedes by". The first term in the search must precede the second by a specified number of terms (n).; W/n = "Within". The terms in the search must be within a specified number of terms (n) in any order.; * = Truncation; " " = Citation Marks; searches for a phrase; ? = replaces one letter; LIMIT-TO (SRCTYPE, "j" = Limit to source type journal; LIMIT-TO (DOCTYPE, "ar" = Limit to document type article; LIMIT-TO (DOCTYPE, "re" = Limit to document type review
Search terms		Items found
Population: Primary care
1.	ALL ( ( family OR general ) W/2 ( physician* OR doctor* OR pract* ) ) OR TITLE-ABS-KEY ( practice* ) OR ALL ( "primary care" ) OR TITLE-ABS-KEY ( "Primary Health Care" ) OR TITLE-ABS-KEY ( primary ) OR TITLE-ABS ( gp ) OR TITLE-ABS ( gps )	7,158,346
Exposure: Relational continuity of care
2.	( TITLE-ABS-KEY ( ( ( continu* ) W/3 ( physician* OR practitioner* OR doctor* OR team* OR provider* OR nurs* OR OR relation* OR "cross-boundary" OR personal OR interpersonal OR care OR healthcare ) ) ) ) OR ( TITLE-ABS-KEY ( ( ( discontinu OR fragment* OR inconsisten* ) W/3 ( care OR healthcare ) ) ) ) OR ( TITLE-ABS-KEY ( ( ( longitudinal* ) W/3 ( care OR healthcare ) ) ) ) OR ( TITLE-ABS-KEY ( ( ( "usual source" OR "regular source" ) W/3 ( care OR healthcare ) ) ) ) OR ( TITLE-ABS-KEY ( ( ( usual* OR regular* OR stabil* ) W/3 ( physician* OR practitioner* OR doctor* OR team* OR provider* OR nurs*) ) ) )	126,569
Study types: systematic reviews and meta-analyses
3.	TITLE-ABS-KEY((systematic W/2 review) OR “meta analys” OR metaanalys) OR (SRCTITLE(cochrane) AND DOCTYPE(re))	598,390
Combined sets
4.	*#1 AND #2 AND #3*	*1,977*
Limits: publication type
5.	#4 AND AND ( EXCLUDE ( DOCTYPE,"cp" ) OR EXCLUDE ( DOCTYPE,"no" ) OR EXCLUDE ( DOCTYPE,"sh" ) OR EXCLUDE ( DOCTYPE,"ed" ) OR EXCLUDE ( DOCTYPE,"ch" ) OR EXCLUDE ( DOCTYPE,"er" ) OR EXCLUDE ( DOCTYPE,"le" ) OR EXCLUDE ( DOCTYPE,"Undefined" ) )	1,902
6.	#5 AND ( EXCLUDE ( LANGUAGE , "Spanish" ) OR EXCLUDE ( LANGUAGE , "German" ) OR EXCLUDE ( LANGUAGE , "Chinese" ) OR EXCLUDE ( LANGUAGE , "French" ) OR EXCLUDE ( LANGUAGE , "Portuguese" ) OR EXCLUDE ( LANGUAGE , "Hungarian" ) OR EXCLUDE ( LANGUAGE , "Italian" ) OR EXCLUDE ( LANGUAGE , "Croatian" ) OR EXCLUDE ( LANGUAGE , "Polish" ) OR EXCLUDE ( LANGUAGE , "Russian" ) )	1,830
7.	#6 AND ( LIMIT-TO ( PUBYEAR , 2022 ) OR LIMIT-TO ( PUBYEAR , 2021 ) OR LIMIT-TO ( PUBYEAR , 2020 ) OR LIMIT-TO ( PUBYEAR , 2019 ) OR LIMIT-TO ( PUBYEAR , 2018 ) OR LIMIT-TO ( PUBYEAR , 2017 ) OR LIMIT-TO ( PUBYEAR , 2016 ) OR LIMIT-TO ( PUBYEAR , 2015 ) OR LIMIT-TO ( PUBYEAR , 2014 ) OR LIMIT-TO ( PUBYEAR , 2013 ) OR LIMIT-TO ( PUBYEAR , 2012 ) )	1,478
Final result
8.	#7	1,478

INAHTA via INAHTA 7 July 2022

Title: Continuity of care in primary care
The final search result, usually found at the end of the documentation, forms the list of abstracts. Title = Title; abs = Abstract; mh = MeSH-term; * = Truncation; " " = Citation Marks; searches for an exact phrase
Search terms		Items found
Population: Primary care
1.	("primary care" OR "primary health care" OR "general practi" OR "family doctor" OR "family physician" OR GP)[Title] OR ("primary care" OR "primary health care" OR "general practi" OR "family doctor" OR "family physician" OR GP)[abs]	472
Exposure: Continuity of care
2.	((continu)[Title] OR (relation)[abs]) OR ("Continuity of Patient Care")[mh])	693
Combined sets
3.	*1 AND 2*	38
Final result
4.	3	38

Page published November 7, 2022

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