Article Figures & Data
Tables
GP = general practitioners in the United Kingdom and Netherlands and family physicians in the United States. -
Being able to see the same patients over time is one of the most rewarding aspects of general practice
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Being able to see the same patients over time contributes to the development of my professional knowledge
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If recording and transfer of patient information is good, there is no need for most patients to see the same GP consistently (reverse coded)
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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)
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Ideally patients should have most of their care provided by the same GP
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Characteristics England & Wales (n = 568) No. (%) Netherlands (n = 502) No. (%) United States (n = 453) No. (%) NA = not applicable. General practitioners Age, years <35 65 (11.4) 35 (7) 62 (13.7) 35–50 310 (54.6) 261 (52) 250 (55.2) >50 190 (33.5) 205 (40.8) 141 (31.1) Sex Male 366 (64.4) 349 (69.5) 295 (65.1) Female 198 (34.9) 153 (30.5) 157 (34.7) Physician, principal Yes 532 (93.7) NA NA No (England and Wales only) 32 (5.6) NA NA Board certified Yes NA NA 427 (94.3) No (US only) NA NA 26 (5.7) Working hours Full time 400 (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 practice 5.33 (2.70) 2.54 (1.59) 5.94 (7.89) Range 1–12 1–9 1–75 Proportion of single-handed practitioners % 6.7 23.2 24.5 List size <6,000 194 (34.2) 390 (77.7) 225 (49.7) >6,000 369 (65.0) 107 (21.3) 217 (47.9) Training practice Yes 245 (43.4) 180 (35.9) 74 (16.3) No 319 (56.2) 321 (63.9) 378 (83.4) Personal list system Yes 163 (28.7) 309 (61.6) NA No 389 (68.5) 189 (37.6) - Table 3.
Perceived Importance of the Types of Continuity of Care in Relation to Quality of Patient Care
Statement England & 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)a 4.53 (0.65)a 4.77 (0.48) <.001 Good recording and transfer of information (informational continuity) 4.66 (0.56)a 4.49 (0.62)b 4.59 (0.59)a,b <.001 Different health professionals working together with you to provide coordinated and consistent care (management continuity) 4.44 (0.68)a 4.17 (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 - 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
Statement England & 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 see 4.31 (0.78)a 4.33 (0.63)a 4.32 (0.88)a .89 There is very good recording and transfer of patient information within my practice 4.03 (0.75)a,b 4.14 (0.69)a 3.87 (0.85)b <.001 There is very good recording and transfer of patient information from health professionals/service providers outside the practice, to my practice 2.89 (0.95) 3.37 (0.8)a 3.21 (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 care 4.14 (0.73)a 4.23 (0.66)a 4.13 (0.77)a .08 Health professionals/service providers outside the practice (eg, hospitals) work with my practice to provide coordinated and consistent care 2.98 (0.90)a 3.06 (0.85)a 3.41 (0.85) <.001 The patients I see can have a wide range of health problems managed within my practice 4.34 (0.69)a 4.19 (0.65)a 4.50 (0.70) <.001 - 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
Statement England & 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 physician 2.79 (1.14)a 2.93 (1.14)a 1.77 (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 physician 2.82 (1.10)a 2.88 (1.08)a 1.80 (0.82) <.001 - Table 6.
Regression of Attitude Toward Personal Continuity on Physicians’ Personal and Practice Characteristics
Characteristic by Country Mean Continuity Score by Group* Regression Coefficient Standard Error PValue * Continuity score minimum 5, maximun 25. England & Wales ( r2 = 0.04) Age, years 0.208 0.242 .39 <35 18.32 35–50: 18.64 50+ 18.78 Sex −0.696 0.340 .04 Male: 18.45 Female 19.03 Full/part time 18.56 0.152 0.359 .67 Full 18.91 Part List size 0.208 0.316 .51 <6000 18.57 >6000 18.70 United States ( r2 = 0.01) Age, years <35 22.40 −0.396 0.191 .04 35–50 22.05 50+ 21.59 Sex −0.088 0.265 .74 Male 21.85 Female 22.17 Full/part time 0.064 0.283 .82 Full 21.93 Part: 22.05 List size −.0116 0.239 .63 <6000 22.04 >6000 21.89 Netherlands ( r2 = 0.04) Age, years 0.274 0.258 .29 <35 19.18 35–50 18.33 50+ 19.07 Sex −0.522 0.360 .15 Male 18.70 Female 18.59 Full/part time −0.998 0.341 .004 Full 19.12 Part 18.14 List size −0.618 0.364 .09 <6000 18.80 >6000 18.09 Personal list −0.326 0.320 .31 Yes 18.85 No 18.31
Additional Files
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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