Continuity of Care in Primary Healthcare Delivery

What is Continuity of Care?

“Continuity of Care” is concerned with quality of care over time. It is the process by which the patient and his/her physician-led care team are cooperatively involved in ongoing health care management toward the shared goal of high quality and cost-effective medical care.

Continuity of care is the primary objective of family medicine and is consistent with quality patient care provided through a patient-centered medical service. The continuity of care approach helps family physicians gain their patients’ confidence. It also facilitates the family physician’s role as a cost-effective coordinator of the patient’s health services by making early recognition of problems possible. This is rooted in a long-term patient-physician partnership in which the physician knows the patient’s history from experience and can integrate new information and decisions from a whole-person perspective efficiently without extensive investigation.

[The above is a lightly edited version of the definition of Continuity of Care from the American Academy of Family Physicians (“AAFP”) website.]

Continuity of care has several dimensions:

  • Relationship continuity: continuous caring relationship with a clinician
  • Management continuity: continuity and consistency of clinical management, including care planning, and any necessary co-ordination of care required by the patient
  • Information continuity: providing and sharing information regarding the patient across all care providers
  • Management continuity is relevant whenever a patient is receiving care from more than one clinician or healthcare provider. It concerns the processes involved in co-ordinating, integrating and personalising care to deliver a high-quality service. The General Physician’s (GPs) clinical responsibility as coordinator of care for patients includes helping patients to understand and plan their treatment, navigate unfamiliar services successfully and remain engaged with their care. Good relationship continuity can contribute substantially to achieving this. Having one principal care provider with a holistic view of the patient is central to patients’ experiences of good management continuity and provides a sense of security and confidence about the future.

     

    Benefits of Continuity of Care

    Continuity of care approach has significant benefits and will result in better care at a lower cost over a period of time. Some of the specific benefits include:

  • Increased trust in the doctor-patient relationship
  • Reduces fragmentation of care and improves patient safety (by reduction of medical errors), quality of care and outcomes in a cost-effective way
  • Enables early recognition of healthcare problems without extensive investigations and unnecessary medication
  • Reduces “collusion of anonymity” when “patient is passed from one specialist to another with nobody taking complete responsibility for the patient
  • Better accuracy of the patient’s medical records
  • Reduction in unplanned hospital admissions
  • Reduction in the use of emergency department
  • Better adherence to medical advice, especially regarding long-term prevention and wellness
  • Empowers patients to take greater ownership for managing their health
  • Reduction in secondary care (medical care provided by a specialist or a facility upon referral by a primary care physician)
  • Improvement in treatment of chronic condition and quality of life of patients
  • Ensures information continuity; patients dislike having to repeat their story to different clinicians
  • Improvement in patient satisfaction
  • Use of Technology in Continuity of Care
    Technology is a major enabler towards ensuring continuity of care. Some of the key technology elements that are widely used for this purpose are:

  • Electronic Health/Medical Record (EHR/EMR): EHR/EMR is vital for maintaining information continuity across various care providers.
  • Continuity of Care Document (CCD): CCD fosters interoperability of clinical data by allowing physicians to send electronic medical information to other providers without loss of meaning, thereby ensuring better patient care.
  • Tele-Medicine: Virtual patient-doctor consultations through tele-medicine platforms will facilitate relationship continuity and enable a physician to provide care to patients remotely.
  • Home Care Medical Devices & Wearables: Data from medical devices and wearables enables the healthcare providers to remotely monitor patients and take timely and proactive action for improved care delivery.
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    Challenges in Continuity of Care

    While there are significant benefits of the continuity of care approach, there are a few challenges that we need to recognize.

  • Relationship continuity is dependant on having access to a particular physician when required. Patients with an urgent problem are often prepared to trade off waiting to see a physician with whom they have a good relationship in favour of an unknown physician.
  • In several cases, patients are willing to sacrifice “continuity of care” and are acceptable to consult with a doctor other than their usual GP. These include:
  • 1. Patients with acute problems (like a chest infection), don’t really care which doctor they see. They are looking for someone who can see them in a timely fashion and will treat them.
    2. Need specialised care from another member of the team
    3. Wish to discuss a problem they find embarrassing to discuss with their regular doctor
    4. Chose to consult a GP of the same gender

  • There are studies to suggest that a fresh start with a new doctor might open new diagnostic perspectives.
  • Seeing the same doctor might not guarantee a good relationship.
  • Patient-doctor relationship continuity might encourage collusion (for e.g., wrongfully getting a sickness certification)
  • Continuity of care can decrease communication if doctor or patient assumes they know (or are known by) the other so well that new issues are not introduced or discussed.
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    “Continuity of Care” does not necessarily mean that the patient will consult with the same doctor each time. This might not be possible. In such cases, we will need to ensure continuity using technology and services of other clinicians in the network. When it comes to continuity, the patients are really looking for the following:

  • They do not have to repeat details of their history and condition each time they meet a new clinician
  • They are not repeatedly handed over from one clinician to another and no one seems to be responsible
  • They are not subjected to unnecessary medication and investigations
  • They do not fall between the cracks as they transition from one treatment setting to another
  • They do not receive conflicting opinions from different clinicians
  • We need to ensure that the patient does not experience the above.

    However, we should endeavour to provide “Continuity of Care” through the same doctor during an “episode of care” (healthcare services for a specific medical problem, condition or illness) for each patient.

    At iKure, “Continuity of Care” is a key focus area and our primary healthcare delivery model is built around this theme. For us, continuity of care involves integrating patient care in his home with our Clinic services through the following:

  • our network of Hub & Spoke clinics
  • regular health intervention programs in the community
  • trained frontline health workers for last mile connectivity
  • our proprietary population health management system
  • integration with medical devices and wearables