Abstract Body

Background and purpose

Continuity of care has many benefits, including a better patient-doctor relationship, prevention of hospital admission, reduced health care costs, better medication compliance, and lower mortality rates.

The aim of this study is to investigate the association between personal continuity and general practice characteristics, and to identify additional factors associated with personal continuity.

Methods

Observational study of 4.7 million contacts of 190.886 patients from 48 different general practices in 2013-2018 in the Netherlands. Personal continuity was calculated using four established measures (Usual Provider Continuity; Bice-Boxerman Continuity of Care Index; Herfindahl Index; Modified Modified Continuity Index). Linear mixed models were used to determine the association between continuity level and practice characteristics, adjusted for patient characteristics. In order to identify additional factors associated with personal continuity, we conducted interviews with general practitioners working in practices with the largest difference between observed and predicted continuity.

Results

We identified nine practice characteristics that were significantly associated with continuity of care (p<0.05). Of these characteristics, six were significant in all models: number of registered patients; number of doctors and their working days; number of locums and their percentage of contacts; number of other employees. These effects were adjusted for patient characteristics, including type of contacts, age, sex, medical history, time of registration, and ancestry (p<0.05). Interviews may provide insights in additional factors (analyses will be completed).

Conclusions

Six characteristics were associated with higher continuity of care, which can be calculated using general practice data. Optimization of these characteristics may contribute to improving personal continuity.

Abstract Body

Background and purpose Continuity is a core value of primary care. In particular personal continuity is associated with significant benefits for patients and general practitioners (GP). However, it has become more challenging for GPs to provide personal continuity due to changes in society and healthcare. The aim of this study was to investigate how GPs and patients views on personal continuity have changed in the past two decades and how it can be improved.

Methods Digital surveys were distributed to 499 GPs and postal surveys were distributed to 1599 patients in the Netherlands. Data collection took place in 2019 and results were analysed with descriptive statistics and thematic analysis.

Results 257 GPs and 584 patients completed the surveys. Sixty percent of GPs found it generally important to see their own patients. Seventy-six percent of patients found it generally important to see their own GP. Suggestions for improving personal continuity were collected from 222 GPs and 378 patients. Suggestions were categorised into nine domains: (1) knowing the patient and mutual understanding, (2) GP accessibility and availability, (3) GP–patient communication, (4) GP responsibility, (5) triage, (6) more time for the patient, (7) transmural care, (8) team continuity and (9) GP vocational training.

Conclusions Both patients and GPs valued personal continuity and these views have not changed much in the past two decades. Both patients and GPs provided extensive input for improving personal continuity. This wide range of suggestions will be used in further research to develop a complex intervention for optimising personal continuity for older patients.