Continuity of care saves lives

A recent paper published in the BMJ collated data from 22 studies and found that contact with the same doctor reduced mortality rates. Of the 22 studies, 18 found a statistically significant reduction in mortality with an increase in continuity of care (repeated contact between a patient and a particular doctor). Whilst all four studies that found inconclusive or negative results had flaws in their design and execution. The understanding gained from the paper is that strong interpersonal relationships between patient and doctor, whether this be GP or hospital doctor, improves the care received and thus survival. It is already known that seeing the same GP every time improves patient satisfaction, increases adherence to medication and reduces hospital admissions. But previous to the studies in this paper, it was unknown if this translated in to improved outcomes i.e. less deaths. Whilst all 22 studies were rated as ‘high quality’, there are some unavoidable issues in studying this topic that could call into question the validity of results. Firstly, there is no consensus among the research or medical community on the best way to measure continuity of care, nor has it been validated that it is a good proxy for a strong doctor-patient relationship. Moreover, the nature of the ‘treatment’ means that only observational studies are possible and that control trials, the gold standard of research, are unethical and impractical. Lastly there is no agreed upon time frame across the papers, so follow up ranged from one weekend to 17 years – suggesting a possible discrepancy in the results. The ‘personal relationship’ in healthcare has becomes less valued as technological advances improve care, but these papers suggest that continuity of care and a strong doctor-patient relationship should be given higher priority in healthcare planning. Although, in a cash strapped NHS, seeing the same doctor is a luxury so it is uncertain whether this youthful research will have any significant impact.

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October 2021
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