Experienced Continuity of Care When Patients See Multiple Clinicians: A Qualitative Metasummary

Jeannie Haggerty et al. outline in their well performed metasummary the hypotheses generated in single studies on problems patients encounter receiving care of multiple clinicians. They state that coordination may be assumed by patients and not observed.

The assessment of management continuity from patients' perspective is difficult. Patient perceptions of inter-professional communication are affected by the appreciation of the communicative skills of the doctors.(1) Several instruments were developed measuring continuity of care but most instruments have problems with either the number or quality of its assessed measurement properties.(2) Possibly, one of the reasons why it is difficult to develop these instruments is that each patient- doctor contact is a combination of communication and medical content. From patients' perspective discrimination between these two aspects is not possible.(1) Haggerty et al. make a valid observation that management continuity is best assessed indirectly by patients through reporting failures and gaps (discontinuity) and informational continuity directly through patients' experience. Improvement of informational continuity is necessary especially when patients are discharged from hospital care as studies from the USA (3) as well as Europe (4) showed. Of the patients from the USA 74% wanted more information. They found that communication was inadequate concerning follow-up, sources of information and to whom questions should be directed.(3) In the Netherlands patients thought it important to receive sufficient information upon discharge from the hospital, but only 84% received sufficient information.(5) All patients treated by more than one specialist felt it is important that specialists keep each other well informed. However, patients experienced this fully in only 55% of cases, in 28% to some extent and not at all in 17%. Above all patients do not want contradictory information from multiple specialists though 19% of them reported having received contradictory information.(5)

1. Berendsen AJ, de Jong GM, Meyboom-de Jong B, Dekker JH, Schuling J. Transition of care: experiences and preferences of patients across the primary / secondary interface - a qualitative study. BMC Health Serv Res. 2009; 9:62.

2. Uijen AA, Heinst CW, Schellevis FG, van den Bosch WJ, van de Laar FA, Terwee CB, Schers HJ. Measurement properties of questionnaires measuring continuity of care: a systematic review. PLoS One. 2012;7(7):e42256.

3. Holland DE, Mistiaen P, Bowles KH. Problems and unmet needs of patients discharged "home to self-care". Prof Case Manag. 2011; 16:240-250.

4. Hesselink G, Flink M, Olsson M, Barach P, Dudzik-Urbaniak E, Orrego C, Toccafondi G, Kalkman C, Johnson JK, Schoonhoven L, Vernooij-Dassen M, Wollersheim H; European HANDOVER Research Collaborative. Are patients discharged with care? A qualitative study of perceptions and experiences of patients, family members and care providers. BMJ Qual Saf. 2012;21 Suppl 1:i39-49.

5. Berendsen AJ, de Jong GM, Schuling J, Bosveld HE, de Waal MW, Mitchell GK, van der MK, Meyboom-de JB. Patient's need for choice and information across the interface between primary and secondary care: A survey. Patient Educ Couns. 2010; 79:100-105.

Competing interests:   None declared