Jump to comment:
- Page navigation anchor for The importance of continuity in tackling multimorbidity in primary care and lessons from the 3D trialThe importance of continuity in tackling multimorbidity in primary care and lessons from the 3D trial
We are interested in the comments of Peter Campion and Serge
...Show MoreAmba’a Engamba about how far the 3D trial provides evidence about the benefits of continuity of care. Although many authors (including ourselves) have provided evidence from cross-sectional or cohort studies about the benefits of continuity,1 there is much less evidence of the benefits of interventions designed to improve continuity. In the 3D study,2 we used a range of strategies to promote continuity, viewing it as one important way to improve patient centred care alongside other changes to the focus of consultations with patients withmultimorbidity .Competing Interests: None declared. - Page navigation anchor for Promoting relational continuity in primary carePromoting relational continuity in primary care
We welcome the interest shown in our paper1 by Professors Campion and Dowrick in their e-letter of the 8/2/2019.2 The 3D trial involved practice-level changes and reviews by nurses, pharmacists and physicians, and measured multiple dimensions linked to patient centred care. This important work was published as our article was undergoing final revisions; we note that the 3D trial by Salisbury et al.3 reported improved patient centred care in the intervention group. But would argue that it has not completely removed the need for more evidence about how prioritising relational continuity improves overall care outcomes
Relational continuity of care has been difficult to define, with different experts using similar nomenclature to refer to different aspects of the doctor-patient relationship. Current interventions have generally aimed to enhance longitudinal continuity - perhaps with the assumption that this indirectly enhances interpersonal continuity (patient-doctor mutual trust) which is core to relational continuity. However, there does not seem to be a focus on interventions directly addressing relational continuity per se. It is therefore understandable that the literature referred to in our paper and in the study by Salisbury et al. both indicate complexities - which need further research.
References
Show More
1. Engamba SA, Steel N, Howe A. Bachman M. Br J...Competing Interests: None declared. - Page navigation anchor for Tackling multimorbidity in primary careTackling multimorbidity in primary careWe were surprised that the authors of this interesting paper (three of whom hold Chairs) had not referenced (Professor) Chris Salisbury’s Lancet paper from July 20181 which establishes that there is a benefit to be gained for patients with more than one chronic health problems, which lies in patient-centred care (“relational continuity” in these authors’ terms). In affirming this, Engamba et al2 claim a lack of evidence, however Salisbury’s study, a randomised controlled trial (of patients with three or more chronic conditions), indicates that patient-centred approach, will benefit this challenging group of patients. In a supporting editorial,3 (Professor) Chris Dowrick notes patients in the intervention reported significantly improved patient-centred care, including discussing problems most important to them, and satisfaction with care (table).We speculate about the reasons why there is such a difference in articles accessed (there are none in common) and conclusions drawn, between these papers. We could debate the extent to which these are distinctly different constructs: but we suspect that each assumes the other. It would be hard to conceive effective patient-centred care in the absence of “relational continuity of care”, the component of Engamba et al’s paper that the authors focus on, and which most closely resembles patient-centre...Show MoreCompeting Interests: None declared.