Interpersonal Continuity of Care and Patient Satisfaction: A Critical Review

Dr. Elizabeth A. Bayliss finds it unlikely that every family physician will be able to provide comprehensive and continuing care to any patient as American health care becomes more complex. I think this depends on how we choose to define comprehensive care. Once upon a time, most of America's family physicians were in solo practice. But this hasn't been the case for over a generation now, and we have never really come to terms with what group practice means to our care model. To me, it is a mistake to equate competence in caring for a disease with the skills needed to care for a patient. Very few of us practice on an island. We have partners, colleagues, and consultants. The real question we are trying to address in our research on interpersonal continuity is, "what should be the primary unit of patient trust and provider responsibility?" For many of our patients, health care is a personal service between two people, regardless of how many teammates stand behind the identified personal physician. We need to understand which patients feel this way and why before we get too far into the process of redesigning American health care.

Competing interests:   None declared

Competing interests:   None declared

In their article, Interpersonal Continuity of Care and Patient Satisfaction: A Critical Review (1), Drs. Saultz and Albedaiwi review the literature on one of the basic tenets of Family Medicine. In doing so they emerge with a consistent message: higher levels of interpersonal continuity of care correlate with higher levels of patient satisfaction. Not only is it reassuring to be reminded that this part of the definition of both family practice and primary care still holds true (2), it is particularly important to do so in the face of potential changes in our health care system.

As we take a critical look at a health care system based on an acute care model and contemplate needed changes, it is worth noting what ‘matters’ to patients. However, it may be worth asking when it matters as well. We care for an increasing population of persons with chronic, not acute, medical conditions. We provide recommended preventive services (estimated to consume up to 7.4 hours per physician per day) (3). Should all care be delivered in the office visit? If so, is it important (or even possible) to have interpersonal continuity of care for each visit? Are there categories of visits for which interpersonal continuity of care matters more or less? Are there ways that we can use appropriate technologies to incorporate some population-based care into continuous relationships? It would be helpful to know if patients prefer, for example, continuity for chronic visits, but less for visits for minor acute illness. Or, as another example, whether interpersonal continuity can be maintained within an office where some preventive care is orchestrated by a nurse specialist.

As our health care system evolves, I think it is unlikely that each primary care physician will be able to provide “comprehensive and continuing” care that addresses all of the acute, chronic, and preventive needs of all patients. Both patients and physicians have weighed in on the value of interpersonal continuity of care. The start of a satisfactory re- engineering of primary health care lies in the shared space where our priorities match. Let us use that knowledge to build an effective and efficient twenty-first century health care system.

1. Saultz JW and Albedaiwi W. Interpersonal continuity of care and patient satisfaction: A critical review. Ann Fam Med 2004;2:445-451.

2. Definitions of Family Practice and Primary Care. American Academy of Family Physicians. www.aafp.org

3. Yarnall KS, Pollak KI, Ostbye T, Krause KM, Michener JL. Primary care: is there enough time for prevention? Am J Public Health 2003;93:635- 41.

Competing interests:   None declared