Measuring continuity of care in general practice: a comparison of two methods using routinely collected data.

Abstract

Background: Despite well documented clinical benefits of longitudinal doctor-patient continuity in primary care, rates have declined. Assessment by practices or health commissioners is rarely undertaken. Aim: Using the Usual Provider of Care (UPC) score this study measures continuity across 126 practices in the mobile, multi-ethnic population of east London, comparing these scores with the General Practice Patient Survey (GPPS) response to questions on GP continuity. Design and Setting: A retrospective, cross sectional study in 126 practices in three east London boroughs. Method: The study population included patients who consulted three or more times between January 2017 – December 2018. Anonymised demographic and consultation data from the electronic health record were linked to results from Q10 of the 2019 General Practice Patient Survey (GPPS). Results: The mean UPC score for all 126 practices was 0.52 (range 0.32 to 0.93). There was a strong correlation between practice UPC scores measured in the two years to December 2018 and responses to the 2019 GPPS question on ‘seeing the doctor you prefer’, Pearson’s r correlation coefficient, 0.62. Smaller practices had higher scores. Multilevel analysis showed higher continuity for patients over 60 years compared to children and younger adults (ẞ-Coefficient 0.082, 95%CI 0.080 to 0.084) and for women. Conclusion: It is possible to measure continuity across all practices in a local health economy. Regular review of practice continuity rates can support efforts to increase continuity within practice teams. This is likely to have positive effects on clinical outcomes and satisfaction for both patients and doctors.