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Research ArticleOriginal Research

Continuity of Care: Is the Personal Doctor Still Important? A Survey of General Practitioners and Family Physicians in England and Wales, the United States, and the Netherlands

Tim Stokes, Carolyn Tarrant, Arch G. Mainous, Henk Schers, George Freeman and Richard Baker
The Annals of Family Medicine July 2005, 3 (4) 353-359; DOI: https://doi.org/10.1370/afm.351
Tim Stokes
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Carolyn Tarrant
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Arch G. Mainous III
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Henk Schers
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George Freeman
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Richard Baker
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    Table 1.

    Statements Combined to Form a Scale of Attitude Toward Personal Continuity

    GP = general practitioners in the United Kingdom and Netherlands and family physicians in the United States.
    1. Being able to see the same patients over time is one of the most rewarding aspects of general practice

    2. Being able to see the same patients over time contributes to the development of my professional knowledge

    3. If recording and transfer of patient information is good, there is no need for most patients to see the same GP consistently (reverse coded)

    4. If different health professionals work together to provide coordinated and consistent care, there is no need for most patients to see the same GP consistently (reverse coded)

    5. Ideally patients should have most of their care provided by the same GP

    • View popup
    Table 2.

    Characteristics of General Practitioners and Practices

    CharacteristicsEngland & Wales (n = 568) No. (%)Netherlands (n = 502) No. (%)United States (n = 453) No. (%)
    NA = not applicable.
    General practitioners
    Age, years
        <3565 (11.4)35 (7)62 (13.7)
        35–50310 (54.6)261 (52)250 (55.2)
        >50190 (33.5)205 (40.8)141 (31.1)
    Sex
        Male366 (64.4)349 (69.5)295 (65.1)
        Female198 (34.9)153 (30.5)157 (34.7)
    Physician, principal
        Yes532 (93.7)NANA
        No (England and Wales only)32 (5.6)NANA
    Board certified
        YesNANA427 (94.3)
        No (US only)NANA26 (5.7)
    Working hours
        Full time400 (70.4)271 (54)343 (75.7)
        Part-time (½ time or more)146 (25.7)220 (43.8)78 (17.2)
        Part-time (< ½ time)17 (3)10 (2)30 (6.6)
    Practices
    Mean (SD) number of physicianss in practice5.33 (2.70)2.54 (1.59)5.94 (7.89)
    Range1–121–91–75
    Proportion of single-handed practitioners %6.723.224.5
    List size
        <6,000194 (34.2)390 (77.7)225 (49.7)
        >6,000369 (65.0)107 (21.3)217 (47.9)
    Training practice
        Yes245 (43.4)180 (35.9)74 (16.3)
        No319 (56.2)321 (63.9)378 (83.4)
    Personal list system
        Yes163 (28.7)309 (61.6)NA
        No389 (68.5)189 (37.6)
    • View popup
    Table 3.

    Perceived Importance of the Types of Continuity of Care in Relation to Quality of Patient Care

    StatementEngland & Wales Mean (SD)Netherlands Mean (SD)United States Mean (SD)PValue*
    Score: 1 = not at all important; 5 = extremely important.
    * Significance of differences between scores by country (1-way analysis of variance).
    a, b = Scores on the same row that share the same subscript do not differ significantly. All other differences between scores on the same row are statistically significant at P <.001 according to the Tukey test comparison.
    Building up relationships over time with the patients that you see (personal continuity)4.60 (0.61)a4.53 (0.65)a4.77 (0.48)<.001
    Good recording and transfer of information (informational continuity)4.66 (0.56)a4.49 (0.62)b4.59 (0.59)a,b<.001
    Different health professionals working together with you to provide coordinated and consistent care (management continuity)4.44 (0.68)a4.17 (0.7)4.52 (0.61)a<.001
    Providing care and management for a wide range of health problems within your practice (management continuity)4.23 (0.76)3.92 (0.81)4.45 (0.69)<.001
    • View popup
    Table 4.

    Extent to Which GPs Felt Able to Provide Different Types of Continuity of Care to Their Patients in Their Day-to-Day Practice

    StatementEngland & Wales Mean (SD)Netherlands Mean (SD)United States Mean (SD)PValue*
    Score: 1 = strongly disagree; 5 = strongly agree.
    * Significance of differences between scores by country (1-way analysis of variance).
    a, b = Scores on the same row that share the same subscript do not differ significantly. All other differences between scores on the same row are statistically significant at P <.001 according to the Tukey comparison.
    I have the opportunity to build up relationships over time with many of the patients I see4.31 (0.78)a4.33 (0.63)a4.32 (0.88)a.89
    There is very good recording and transfer of patient information within my practice4.03 (0.75)a,b4.14 (0.69)a3.87 (0.85)b<.001
    There is very good recording and transfer of patient information from health professionals/service providers outside the practice, to my practice2.89 (0.95)3.37 (0.8)a3.21 (0.89)a<.001
    The physicians, nurses and other health professionals in my practice (employed and attached staff) work together to provide coordinated and consistent care4.14 (0.73)a4.23 (0.66)a4.13 (0.77)a.08
    Health professionals/service providers outside the practice (eg, hospitals) work with my practice to provide coordinated and consistent care2.98 (0.90)a3.06 (0.85)a3.41 (0.85)<.001
    The patients I see can have a wide range of health problems managed within my practice4.34 (0.69)a4.19 (0.65)a4.50 (0.70)<.001
    • View popup
    Table 5.

    Extent to Which GPs Agree That the Provision of Personal Continuity of Care to Their Patients Can Be Substituted for by Other Types of Continuity

    StatementEngland & Wales Mean (SD)Netherlands Mean (SD)United States Mean (SD)PValue*
    Score: 1 = strongly disagree; 5 = strongly agree.
    * Significance of differences between scores by country (1-way analysis of variance).
    a, b: Scores on the same row that share the same subscript do not differ significantly. All other differences between scores on the same row are statistically significant at P <.001 according to the Tukey test comparison.
    If recording and transfer of patient information is good, there is no need for most patients to consistently see the same physician2.79 (1.14)a2.93 (1.14)a1.77 (0.82)<.001
    If different health professionals work together to provide coordinated and consistent care, there is no need for most patients to consistently see the same physician2.82 (1.10)a2.88 (1.08)a1.80 (0.82)<.001
    • View popup
    Table 6.

    Regression of Attitude Toward Personal Continuity on Physicians’ Personal and Practice Characteristics

    Characteristic by CountryMean Continuity Score by Group*Regression CoefficientStandard ErrorPValue
    * Continuity score minimum 5, maximun 25.
    England & Wales ( r2 = 0.04)
    Age, years0.2080.242.39
        <3518.32
        35–50:18.64
        50+18.78
    Sex−0.6960.340.04
        Male:18.45
        Female19.03
    Full/part time18.560.1520.359.67
        Full18.91
        Part
    List size0.2080.316.51
        <600018.57
        >600018.70
    United States ( r2 = 0.01)
    Age, years
        <3522.40−0.3960.191.04
        35–5022.05
        50+21.59
    Sex−0.0880.265.74
        Male21.85
        Female22.17
    Full/part time0.0640.283.82
        Full21.93
        Part:22.05
    List size−.01160.239.63
        <600022.04
        >600021.89
    Netherlands ( r2 = 0.04)
    Age, years0.2740.258.29
        <3519.18
        35–5018.33
        50+19.07
    Sex−0.5220.360.15
        Male18.70
        Female18.59
    Full/part time−0.9980.341.004
        Full19.12
        Part18.14
    List size−0.6180.364.09
        <600018.80
        >600018.09
    Personal list−0.3260.320.31
        Yes18.85
        No18.31

Additional Files

  • Tables
  • Supplemental Appendix

    Supplementary Appendix. National Survey of General Practitioners� Views on Continuity of Care.

    Files in this Data Supplement:

    • Supplemental data: Appendix - PDF file, 3 pages, 123 KB
  • The Article in Brief

    Background: Although patients often want an ongoing relationship with a medical professional (referred to as personal continuity of care), changes in health care policies and the way that health care is organized have made it more difficult to maintain such relationships. This study surveyed 1,523 general practitioners and family physicians in England and Wales, the Netherlands, and the United States on their views of continuity of care.
    What This Study Found: Doctors in all 4 countries feel strongly that personal continuity of care (the ongoing relationship between a patient and a medical professional) is an important part of good quality care. Most doctors surveyed think that personal continuity cannot be replaced by continuity in other areas, such as medical information or management of a patient�s medical condition.
    Implications:
    � Even in very different health care systems, with different patient expectations and cultural influences, doctors place a high value on maintaining the patient-physician relationship through personal continuity.
    � The importance of personal continuity to patients and doctors should be taken into account by policy makers.

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The Annals of Family Medicine: 3 (4)
The Annals of Family Medicine: 3 (4)
Vol. 3, Issue 4
1 Jul 2005
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Continuity of Care: Is the Personal Doctor Still Important? A Survey of General Practitioners and Family Physicians in England and Wales, the United States, and the Netherlands
Tim Stokes, Carolyn Tarrant, Arch G. Mainous, Henk Schers, George Freeman, Richard Baker
The Annals of Family Medicine Jul 2005, 3 (4) 353-359; DOI: 10.1370/afm.351

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Continuity of Care: Is the Personal Doctor Still Important? A Survey of General Practitioners and Family Physicians in England and Wales, the United States, and the Netherlands
Tim Stokes, Carolyn Tarrant, Arch G. Mainous, Henk Schers, George Freeman, Richard Baker
The Annals of Family Medicine Jul 2005, 3 (4) 353-359; DOI: 10.1370/afm.351
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