Continuity of care in general practice and secondary care: retrospective cohort study

Background: Better continuity in primary and secondary care is linked to improved health outcomes, but it is unclear whether the sociodemographic determinants of continuity are the same in both settings and whether continuity measures in each setting are associated.

Aim: To examine the determinants of relational continuity in general practice (GP) and fragmented outpatient specialty care in people with clusters of Multiple Long-Term Conditions (LTCs) and the association between continuity in each setting.

Design and setting: A cohort of patients ≥18 years registered to general practices in England throughout 2019, and with linked hospital outpatient records. Patients with two or more of 212 LTCs and with at least three GP and three outpatient appointments were included.

Method: The Continuity of Care Index (COCI) was calculated separately for visits to the same i) GP and ii) outpatient specialty and we calculated associations of sociodemographic factors and number of LTCs with COCI scores. We also assessed the association between indices in each setting using univariable and multivariable fractional logit regression.

Results: Of 1,135,903 patients, 56.2% were ≥60 years. Age was the strongest determinant of continuity in GP, whereas number of LTCs was the strongest determinant in secondary care. Although statistically significant (p<0.001) the relationship between the COCI in GP and outpatients was clinically insignificant in both univariable and multivariable models.

Conclusion: We found a lack of strong association between continuity of care in GP and outpatient settings. This suggests that fragmented hospital care is not mitigated by increased continuity in GP.