General practice and patient characteristics associated with personal continuity: mixed methods study

Abstract

Background: Personal continuity is a core value of general practice. It is increasingly threatened by societal and healthcare changes. Aim: To 1) investigate the association between personal continuity and practice and patient characteristics; and 2) incorporate general practitioners (GPs)’ views to enrich and validate our quantitative findings. Design and Setting: A mixed methods study based on observational, routinely collected healthcare data of 269,478 patients from 48 Dutch general practices (2013-2018) and interviews with selected GPs. Methods: First, we related four different personal continuity outcome measures to eight practice and twelve patient characteristics by multilevel linear regression analyses. Second, we performed a thematic analysis of semi-structured interviews with ten GPs to include their views on factors attributing to personal (dis)continuity. These GPs worked at the ten practices with the largest difference between calculated and model-estimated personal continuity. Results: We found that an increased number of usual GPs and contacts by locum GPs were dose-dependently associated with lower personal continuity (highest vs. lowest quartile -0.094 and -0.095, P<0.001), whereas days since enlistment was dose-dependently associated with higher personal continuity (highest vs. lowest quartile +0.017, P<0.001). Older age, number of chronic conditions and contacts were also associated with higher personal continuity. The in-depth interviews identified three key themes affecting personal continuity: team composition, practice organisation and personal views. Conclusion: Personal continuity is associated with practice and patient characteristics. The dose-dependent associations suggest a causal relationship and, complemented by GPs’ views, may provide practical targets to improve personal continuity directly.