Continuity of care in diverse ethnic groups: a general practice record study in England

Mai Stafford; Laia Bécares; Brenda Hayanga; Mark Ashworth; Rebecca Fisher

doi:10.3399/BJGP.2022.0271

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Does continuity of care associate with long-term conditions? Response to Matin Jafari
Mai Stafford, Brenda Hayanga, Mark Ashworth, Laia Becares and Rebecca Fisher

Published on: 30 May 2023
Does continuity of care associate with long-term conditions?
Matin Jafari

Published on: 22 May 2023
Easy Japanese mitigating language barrier to continuity of care
Ryuichi Ohta

Published on: 20 April 2023

Published on: (30 May 2023)
Page navigation anchor for Does continuity of care associate with long-term conditions? Response to Matin Jafari
Does continuity of care associate with long-term conditions? Response to Matin Jafari
Mai Stafford, Researcher, The Health Foundation
Other Contributors:
Brenda Hayanga, Researcher, Kings College London

Mark Ashworth, Researcher, Kings College London

Laia Becares, Researcher, Kings College London

Rebecca Fisher, GP, The Health Foundation
We thank Matin Jafari for their interest in our paper on ethnic inequalities in continuity of care.¹ Their work shows the value to nursing staff of having high continuity of care in the ICU setting.² This highlights that continuity is an important theme beyond as well as within general practice. However, the experiences of continuity of care for older Iranians in ICU may be different from general practice in England and comparisons should be done with caution.

We limited our study to those who had three or more consultations because relational continuity of care is established over a reasonably long timeframe.³ In our original sample of 690,000 people registered in general practice in England, a total of 276,293 had fewer than three consultations with their GP.

Having two or more long-term conditions was less common in people with fewer than three consultations (see Table). Mean follow-up time was shortest for people with no consultation (135 days), possibly indicating greater residential mobility. In summary, people excluded from our analysis because they had fewer than three consultations tended to be a younger, more mobile and generally healthier group than the analytical sample, although it remains possible that some may have health conditions for which healthcare was not sought or which were not identified or coded b...
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We thank Matin Jafari for their interest in our paper on ethnic inequalities in continuity of care.¹ Their work shows the value to nursing staff of having high continuity of care in the ICU setting.² This highlights that continuity is an important theme beyond as well as within general practice. However, the experiences of continuity of care for older Iranians in ICU may be different from general practice in England and comparisons should be done with caution.

We limited our study to those who had three or more consultations because relational continuity of care is established over a reasonably long timeframe.³ In our original sample of 690,000 people registered in general practice in England, a total of 276,293 had fewer than three consultations with their GP.

Having two or more long-term conditions was less common in people with fewer than three consultations (see Table). Mean follow-up time was shortest for people with no consultation (135 days), possibly indicating greater residential mobility. In summary, people excluded from our analysis because they had fewer than three consultations tended to be a younger, more mobile and generally healthier group than the analytical sample, although it remains possible that some may have health conditions for which healthcare was not sought or which were not identified or coded by their GP. The concept of relational continuity of care with an individual GP is less relevant for this group but other aspects of continuity, such as informational continuity, may be equally important for the residentially mobile subset.^4,5

References

1. Stafford M, Bécares L, Hayanga B, Ashworth M, Fisher R. Continuity of care in diverse ethnic groups: a general practice record study in England. Br J Gen Pract 2023; 73 (729): e257-e266.
2. Jafari M. Does continuity of care associate with long-term conditions? Br J Gen Pract 2023. https://bjgp.org/content/73/729/e257/tab-e-letters.
3. Hull SA, Williams C, Schofield P, Boomla K, Ashworth M. Measuring continuity of care in general practice: a comparison of two methods using routinely collected data. Br J Gen Pract 2022; 72(724): e773-446.
4. Haggerty JL, Reid RJ, Freeman GK, et al. Continuity of care: a multidisciplinary review. BMJ 2003; 327: 7425, 1219–1221.
5. Ladds E, Greenhalgh T. Modernising continuity: a new conceptual framework. Br J Gen Pract 2023; 73(731): 246-248.
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Competing Interests: None declared.
Published on: (22 May 2023)
Page navigation anchor for Does continuity of care associate with long-term conditions?
Does continuity of care associate with long-term conditions?
Matin Jafari, Pharm.D/MPH Student, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
Stafford et al recently published an article focusing on capturing continuity of care in diverse ethnic groups. However, discussion of other parameters such as age, gender, long-term conditions (mental and physical), and their relationship to continuity of care is a valuable contribution to the field of continuity of care.¹

Greater continuity of care and better coordination are the goals to overcome fragmentation in health care delivery systems. Continuity and coordination are two concepts that lead to 'integrated care.'²

One of the hypotheses of the article was that certain patterns would emerge among people with multiple physical health conditions and among people with a long-term condition.
According to previous research presented in the introduction, there were mixed results regarding the relationship between continuity of care and long-term conditions. The study of the challenges of elderly patients with multiple illnesses in Iran showed that continuity of care was a discomfort and stress factor for these patients.^1,3

In the minimally adjusted models, continuity of care increased with each additional long-term condition. In the multiple-adjusted analysis, although individuals with ≥2 physical health conditions had lower continuity of care, continuity remained higher for individuals with ≥2 mental health conditions.

The multiple findings regarding the association between continui...
Show More

Stafford et al recently published an article focusing on capturing continuity of care in diverse ethnic groups. However, discussion of other parameters such as age, gender, long-term conditions (mental and physical), and their relationship to continuity of care is a valuable contribution to the field of continuity of care.¹

Greater continuity of care and better coordination are the goals to overcome fragmentation in health care delivery systems. Continuity and coordination are two concepts that lead to 'integrated care.'²

One of the hypotheses of the article was that certain patterns would emerge among people with multiple physical health conditions and among people with a long-term condition.
According to previous research presented in the introduction, there were mixed results regarding the relationship between continuity of care and long-term conditions. The study of the challenges of elderly patients with multiple illnesses in Iran showed that continuity of care was a discomfort and stress factor for these patients.^1,3

In the minimally adjusted models, continuity of care increased with each additional long-term condition. In the multiple-adjusted analysis, although individuals with ≥2 physical health conditions had lower continuity of care, continuity remained higher for individuals with ≥2 mental health conditions.

The multiple findings regarding the association between continuity of care and long-term conditions provide deeper insight into the findings of M Stafford et al. Data collection from patients shows that patients with ≤3 GP consultations were excluded from the original sample. The total number of excluded patients is a substantial proportion of the original sample (276,293 patients out of 690000 patients). These patients are excluded without consideration.

How many of the patients with ≤3 GP consultations have long-term conditions?
Did the long-term conditions result in a low number of GP consultations?
Patients were excluded without affecting the validity of the article on long-term conditions and continuity of care.

Therefore, to understand the association between long-term conditions and continuity of care, a closer look at those with ≤3 GP consultations is needed.

References
1. Stafford, M., Bécares, L., Hayanga, B., Ashworth, M., & Fisher, R. Continuity of care in diverse ethnic groups: a general practice record study in England. Br J Gen Pract 2023;73(729): e257-e266.
2. Shaw, S., Rosen, R., & Rumbold, B. What is integrated care. London: Nuffield Trust, 2011. 7, 1-23.
3. Heydari, A., Sharifi, M., & Moghaddam, A. B. Challenges and barriers to providing care to older adult patients in the intensive care unit: A qualitative research. Open Access Maced J Med Sci 2019; 7(21): 3682.

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Competing Interests: None declared.
Published on: (20 April 2023)
Page navigation anchor for Easy Japanese mitigating language barrier to continuity of care
Easy Japanese mitigating language barrier to continuity of care
Ryuichi Ohta, Family physician, Unnan City Hospital, Japan
As one of the factors impinging on the continuity of care, ethnic minorities in deprived areas have less continuity of care, deteriorating their health conditions.¹ The continuity of care can be affected by factors such as culture and patients’ socioeconomic status. Multiple-layer interventions are needed in respecting patients’ backgrounds to improve continuity of care. Rural contexts can be in the same situations with deprivation. Ethnic minorities in rural areas, such as immigrants, have difficulty maintaining the continuity of care, especially in rural Japan.
Another critical barrier to the continuity of care is language issues among medical professionals in rural Japan. Japan is a monogamous country, and over 90% of the population is Japanese. Immigrants from different countries as ethnic minorities had various difficulties using medical care. One of the mitigating methods of the language barrier is Easy Japanese, which is spreading over Japan, mainly among healthcare professionals.² Easy Japanese was established in Japan to mitigate foreigners’ difficulty in understanding the Japanese language. Easy Japanese is mainly characterized by initially short sentences, the conclusion, and avoiding polite Japanese words. The concept of mitigating the language barrier is vital, but the continual provision of the policy is challenging.³Future studies should investigate the continuity of the activities such as Easy...
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As one of the factors impinging on the continuity of care, ethnic minorities in deprived areas have less continuity of care, deteriorating their health conditions.¹ The continuity of care can be affected by factors such as culture and patients’ socioeconomic status. Multiple-layer interventions are needed in respecting patients’ backgrounds to improve continuity of care. Rural contexts can be in the same situations with deprivation. Ethnic minorities in rural areas, such as immigrants, have difficulty maintaining the continuity of care, especially in rural Japan.
Another critical barrier to the continuity of care is language issues among medical professionals in rural Japan. Japan is a monogamous country, and over 90% of the population is Japanese. Immigrants from different countries as ethnic minorities had various difficulties using medical care. One of the mitigating methods of the language barrier is Easy Japanese, which is spreading over Japan, mainly among healthcare professionals.² Easy Japanese was established in Japan to mitigate foreigners’ difficulty in understanding the Japanese language. Easy Japanese is mainly characterized by initially short sentences, the conclusion, and avoiding polite Japanese words. The concept of mitigating the language barrier is vital, but the continual provision of the policy is challenging.³Future studies should investigate the continuity of the activities such as Easy Japanese and its effects on the continuity of care in communities.

References
1. Stafford M, Becares L, Hayanga B, Ashworth M, Fisher R. Continuity of care in diverse ethnic groups: a general practice record study in England. Br J Gen Pract 2023, 73(729): e257-e266. DOI: 10.3399/BJGP.2022.0271.
2. Ohta R, Sano C. Rural Easy Japanese as a Method of Mitigating Language Barriers Among Foreigners Seeking Medical Care in Rural Japan. Cureus 2022, 14(7): e26693. DOI: 10.7759/cureus.26693.
3. de Moissac D, Bowen S. Impact of Language Barriers on Quality of Care and Patient Safety for Official Language Minority Francophones in Canada. J Patient Exp 2019, 6(1):24-32. DOI: 10.1177/2374373518769008.

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Competing Interests: None declared.