Continuity of care in general practice and secondary care: retrospective cohort study
Author(s)
Beaney, Thomas
Woodcock, Thomas
Aylin, Paul
Majeed, Azeem
Clarke, Jonathan
Type
Journal Article
Abstract
Background Better continuity in primary and secondary care is linked to improved health outcomes, but it is unclear whether the sociodemographic determinants of continuity are the same in both settings and whether continuity measures in each setting are associated.
Aim To examine the determinants of relational continuity in general practice and fragmented outpatient specialty care in people with clusters of multiple long-term conditions (LTCs) and the association between continuity in each setting.
Design & setting A cohort of patients aged ≥18 years registered to general practices in England throughout 2019 and who had linked hospital outpatient records. Patients with ≥2 of 212 LTCs and with ≥3 general practice and ≥3 outpatient appointments were included.
Method The Continuity of Care Index (COCI) was calculated separately for visits to the same a) GP and b) outpatient specialty, and associations calculated for sociodemographic factors and number of LTCs with COCI scores. The association was also assessed between indices in each setting using univariable and multivariable fractional logit regression.
Results Of 1 135 903 patients, 56.3% (n = 639 489)were aged ≥60 years. Age was the strongest determinant of continuity in general practice, whereas number of LTCs was the strongest determinant in secondary care. Although statistically significant (P<0.001), the relationship between the COCI in general practice and outpatients was clinically insignificant in both univariable and multivariable models.
Conclusion A lack of strong association between continuity of care in general practice and outpatient settings was found. This suggests that fragmented hospital care is not mitigated by increased continuity in general practice.
Aim To examine the determinants of relational continuity in general practice and fragmented outpatient specialty care in people with clusters of multiple long-term conditions (LTCs) and the association between continuity in each setting.
Design & setting A cohort of patients aged ≥18 years registered to general practices in England throughout 2019 and who had linked hospital outpatient records. Patients with ≥2 of 212 LTCs and with ≥3 general practice and ≥3 outpatient appointments were included.
Method The Continuity of Care Index (COCI) was calculated separately for visits to the same a) GP and b) outpatient specialty, and associations calculated for sociodemographic factors and number of LTCs with COCI scores. The association was also assessed between indices in each setting using univariable and multivariable fractional logit regression.
Results Of 1 135 903 patients, 56.3% (n = 639 489)were aged ≥60 years. Age was the strongest determinant of continuity in general practice, whereas number of LTCs was the strongest determinant in secondary care. Although statistically significant (P<0.001), the relationship between the COCI in general practice and outpatients was clinically insignificant in both univariable and multivariable models.
Conclusion A lack of strong association between continuity of care in general practice and outpatient settings was found. This suggests that fragmented hospital care is not mitigated by increased continuity in general practice.
Date Issued
2025-08-01
Date Acceptance
2024-12-09
Citation
British Journal of General Practice, 2025, 75 (757), pp.e533-e540
ISSN
0960-1643
Publisher
Royal College of General Practitioners
Start Page
e533
End Page
e540
Journal / Book Title
British Journal of General Practice
Volume
75
Issue
757
Copyright Statement
© The Authors http://creativecommons.org/licenses/by/4.0/ This article is Open Access: CC BY 4.0 licence (http://creativecommons.org/licenses/by/4.0/).
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/39667776
PII: BJGP.2024.0579
Subjects
continuity of care
multimorbidity
multiple long-term conditions
primary health care
secondary care
sociodemographic factors
Humans
Continuity of Patient Care
Secondary Care
Male
Female
General Practice
Middle Aged
Retrospective Studies
Aged
England
Adult
Ambulatory Care
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2024-12-12