Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Oct 27;72(724):e780-e789.
doi: 10.3399/BJGP.2022.0038. Print 2022 Nov.

General practice and patient characteristics associated with personal continuity: a mixed-methods study

Marije T Te Winkel  1 , Pauline Slottje  2 , Anja Jtcm de Kruif  3 , Birgit I Lissenberg-Witte  4 , Rob J van Marum  5 , Henk J Schers  6 , Annemarie A Uijen  6 , Jettie Bont  7 , Otto R Maarsingh  1
Affiliations

General practice and patient characteristics associated with personal continuity: a mixed-methods study

Marije T Te Winkel et al. Br J Gen Pract. .

Abstract

Background: Personal continuity of care is a core value of general practice. It is increasingly threatened by societal and healthcare changes.

Aim: To investigate the association between personal continuity and both practice and patient characteristics; and to incorporate GPs' views to enrich and validate the quantitative findings.

Design and setting: A mixed-methods study based on observational, routinely collected healthcare data from 269 478 patients from 48 Dutch general practices (2013-2018) and interviews with selected GPs.

Method: First, four different personal continuity outcome measures were calculated relating to eight practice and 12 patient characteristics using multilevel linear regression analyses. Second, a thematic analysis was performed of semi-structured interviews with 10 GPs to include their views on factors contributing to personal (dis) continuity. These GPs worked at the 10 practices with the largest difference between calculated and model-estimated personal continuity.

Results: Both a larger number of usual GPs working in a practice and a larger percentage of patient contacts with locum GPs were dose-dependently associated with lower personal continuity (highest versus lowest quartile -0.094 and -0.092, respectively, P<0.001), whereas days since registration with the general practice was dose-dependently associated with higher personal continuity (highest versus lowest quartile +0.017, P<0.001). Older age, number of chronic conditions, and contacts were also associated with higher personal continuity. The in-depth interviews identified three key themes affecting personal continuity: team composition, practice organisation, and the personal views of the GPs.

Conclusion: Personal continuity is associated with practice and patient characteristics. The dose-dependent associations suggest a causal relationship and, complemented by GPs' views, may provide practical targets to improve personal continuity directly.

Keywords: continuity of patient care; general practice; mixed methods; personal continuity; primary health care.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Selection of the final study population. Area estimate = estimates based on areas with the same zip code. GP contacts = contacts with a GP.
Figure 2.
Figure 2.
Key themes influencing levels of personal continuity according to the GPs.
See this image and copyright information in PMC

References

    1. Guthrie B, Saultz JW, Freeman GK, Haggerty JL. Continuity of care matters. BMJ. 2008;337:a867. - PubMed
    1. Stokes T, Tarrant C, Mainous AG, 3rd, et al. Continuity of care: is the personal doctor still important? A survey of general practitioners and family physicians in England and Wales, the United States, and the Netherlands. Ann Fam Med. 2005;3(4):353–359. - PMC - PubMed
    1. Freeman GK, Olesen F, Hjortdahl P. Continuity of care: an essential element of modern general practice? Fam Pract. 2003;20(6):623–627. - PubMed
    1. Van der Horst HE, Dijkstra R. [General practice core values and core tasks recalibrated]. [Article in Dutch] Huisarts Wet. 2019;62:19–22.
    1. Haggerty JL, Reid RJ, Freeman GK, et al. Continuity of care: a multidisciplinary review. BMJ. 2003;327(7425):1219–1221. - PMC - PubMed

LinkOut - more resources