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Better primary care continuity is associated with lower mortality risk
Question clinique
Is continuity of care associated with decreased mortality?
L’Essentiel
Most studies in this systematic review found a protective effect of greater primary care continuity and all-cause mortality. 2a
Référence
Plan de l'etude: Systematic review
Financement: Self-funded or unfunded
Cadre: Outpatient (primary care)
Sommaire
These authors searched several databases and the gray literature to identify 13 empiric studies that reported measures of continuity and mortality in patients seen in primary care settings. All the studies evaluated continuity of care via care-use patterns or patient report. Only 2 of the studies included nurse practitioners or physicians assistants. The nature of the studies and their data prevented formal meta-analysis. A limitation of this review is that the studies only evaluated personal continuity (ongoing relationship with a provider), not informational continuity (accessibility of records) or management continuity (coordination between all groups involved in care). Twelve studies evaluated all-cause mortality, 9 of which found a statistically significant lower mortality risk associated with greater continuity, 2 found no association, and 1 found that the association changed based on the measure of continuity used. Two studies found lower risks of coronary heart disease mortality with greater continuity and one found lower mortality risks from cancer or chronic obstructive lung disease. The authors go on and extract from the studies potential mechanisms to explain the associations, but, frankly, it is all just speculation and begs the real issue: How to cultivate more primary care clinicians and how to encourage health care systems to prioritize the delivery of primary care.
Reviewer
Henry C. Barry, MD, MS
Professor
Michigan State University
East Lansing, MI
Commentaires
continuity of care
The "team" approach promotes discontinuity in that the players keep changing. I believe it is the individual relationships that matter. I had one family under my care for 40+ years. "Someone is looking after me."
Quality of relationship
Continuity of care seems important; however, I’d be more interested in seeing research on frequency of visits, and patients’ perception (on a scale from 0-10) of their provider. “Do you think your doctor actually cares about you?” and “How competent do you think your doctor is?”
How to cultivate more primary care physicians: PAY THEM
Really, as long as you can provide episodic care for 2 to 3 times as much as continuous care, you know where most clinicians will go. Just like the devaluing of education and childcare, continuous care provides the highest value for the lowest provider remuneration. It’s just sad!
Primary Care and reduced morbidity
The present healthcare scenario does not accommodate this ideal setting. Family Doctors are almost all under huge pressure and time constraints. The best at this, in my experience are female MDs.
There are long wait times to get signed up for a GP and no signs of it getting better.
Yet another example of why a complete re-think and overhaul of the Healthcare system in Canada is so necessary and urgent.
Primary care continuity and lower mortality risk
Confirms what we all know intuitively: the presence of a single primary care provider over the long term improves health in populations!
decreased mortality in pts with regular family MD
I believe this is true
Primary care continuity
The key word here is 'better'. What defines better? Continuity may be there but of low quality. Despite studies like this, those who have knowledge of how patients fall through the cracks when "COC" is absent or inadequate, are aware that better care is not easy to deliver.
Continuity of care
It is rewarding to see that the corner stone of family practice is standing up to scientific scrutiny.
Sort of a statement of the obvious, really
It's always nice to see these confirmations.