“A sustained partnership between patients and clinicians”1 is held by the Institute of Medicine (IOM) to be a critical element of primary care. This sustained partnership is commonly called continuity of care. It is a cornerstone for realizing other aspects of primary care, as defined by the IOM, including integration of care, accountability for a large majority of personal health care needs, and practicing in the context of family and community.
The ability of patients and clinicians to achieve this sustained partnership is under attack. Health care system changes are resulting in forced discontinuity of care.2,3 This disruption differentially affects vulnerable patients.4 If the trend is not reversed soon, a generation of patients and clinicians will live without the everyday experience of longitudinal, trusting, healing relationships. Not knowing the possibilities inherent in these relationships, we will not make the best decisions about individual health care or systems redesign.5
It is therefore timely that a cluster of early manuscripts submitted to the Annals focused on important questions about continuity of care. Continuity is important to clinicians, but does it matter to patients? If so, which patients and when?6 Does continuity affect important health care outcomes, such as the quality of diabetes care?7 Does it matter for health care costs8,9 or utilization?9 What are the important dimensions of continuity in the interpersonal healing relationship, and how can these be measured to advance understanding?10 Is continuity merely part of the process of care, or do we know enough about its effects to consider it to be an important outcome?11
Research articles by Nutting and colleagues,6 Gill et al,7 Saultz,10 Franks et al,9 and De Maeseneer et al,8 and an editorial by Christakis11 tackle these and related questions. Together, they sharpen our focus on what is important about continuity, for whom, and in what situations. They point to the need to pay attention to the crisis in continuity and the lack of systems support for healing relationships.5 They point the way toward future research on this foundational topic. We encourage readers who have experience with continuity or its absence to take part in the online discussion of these articles at www.annfammed.org. The diverse perspectives of patients, clinicians, and policymakers are important in fully exploring this important issue.
We encourage readers to participate also in the discussion of the other research papers in this issue. The study by Sax and Kautz12 finds that teachers are the most common source of referral for consideration of the diagnosis of attention-deficit/hyperactivity disorder. Knowing the source of referral might have important implications for identifying children with ADHD and preventing overdiagnosis. The essay by Frey13 shares the hopeful story of a young immigrant. It gives us a flavor of what a culturally attentive clinician can appreciate and what a supportive social context can achieve.
Readers continue to share important insights in TRACK, the Annals online discussion of articles. In this issue’s On-TRACK, Senior Associate Editor William Phillips identifies several interesting themes from recent discussions. We value your continued participation.
- © 2003 Annals of Family Medicine, Inc.
