Within the literature there has indeed been a focus on the importance of continuity of care. A number of studies have been carried out, principally in the area of general practice. Key studies in Norway showed that continuous care not only increased patient satisfaction but also allowed the doctor to accumulate knowledge that saved time, influenced their use of laboratory tests, allowed for expectant management, and to a lesser degree affected the use of medication.1,2
Patients were shown to value their relationship with their doctor more and felt they had more control over their health.2
Patients were not only more satisfied with the service, but the reduction in time and the more judicious use of investigations all improved the efficiency of the system. This was especially so in consultations with children, the elderly, patients with psychosocial problems and those with chronic diseases.1
Studies of interest have also been carried out in the United States as part of an attempt to improve the health care provided via the publicly aided Medicaid system. One of the aims was to explore if improved continuity could influence the quality of clinical care. Evidence from a randomised controlled trial suggests that it does.3
This trial was carried out in an outpatient population of elderly men and showed that improved continuity of care almost halved the number of emergency admissions and shortened the length of hospitalisation. The patients in the continuity group perceived that the providers were more knowledgeable, thorough and interested in patient education.3
Other studies have demonstrated that there is a direct positive effect on actual clinical outcomes. For example, in a cohort of adults with a diagnosis of type II diabetes, patients with higher continuity scores had better HbA1c
values and more positive changes to their diets.4
There are fewer studies in children, but improved continuity has been shown to be associated with a better uptake of routine health services such as immunisation and preventative services.5
Like adults, children with diabetes have been shown to have better diabetic control with fewer acute admissions for ketoacidosis and a better uptake of screening services such as retinal and endocrine testing.6
Significantly fewer emergency department visits are also seen in children with improved continuity.7
One review article discusses the views of general practitioners on continuity.8
It suggests that the main costs for clinicians when offering increased continuity are personal commitment and high personal availability. Doctors are caught between the conflicting pressures of patient's expectations and society's demands. To be asked for personally by a patient is more satisfying than seeing a succession of patients who just want a doctor. However, this needs to be balanced against many doctors opting away from a full‐time job for life. Seeing the same patients increases job satisfaction and education but requires high personal commitment. The article emphasises that continuity is important to patients in general practice, who give it as their third priority after a doctor who listens and a doctor who sorts out problems.
The evidence, therefore, indicates that continuity is valuable and important to doctors and patients. It not only enables us to have an improved relationship with our patients but also enables us to work more effectively and, most importantly, results in improved clinical outcomes. But our health care system is very different from Medicaid in the United States, where most of this work has been carried out to improve the health of individuals from lower social classes and ethnic minorities. Before we can assume that this evidence is relevant on our side of the Atlantic, we need to know whether we have (dis)continuity of care to the same extent here in the UK.