Continuity of medical care reduces patient mortality

By Bianca Nogrady
Continuity of care in medicine not only improves patient health outcomes, but is also linked to reduced mortality, new research suggests.

BMJ Open has published a systematic review of 22 studies, which all reported measured continuity of care received by patients from any kind of doctor in any setting and related that to patient mortality.

The researchers found that 18 high-quality studies showed statistically significant reductions in patient mortality that were associated with better continuity of care. For example, one study in patients with diabetes showed a 53% reduction in mortality risk with higher continuity of care, while another found a twofold increase in mortality among patients readmitted to the same hospital but under a different surgeon.

‘The effect sizes were generally small but these were in the same range as some treatment effects, as very large, repeatable effects on mortality are rare,’ the researchers wrote.

Two studies found no significant association between continuity of care and patient mortality, but the researchers argued that these measured continuity on very short timescales so their ability to measure the strength of the doctor-patient relationship was ‘potentially questionable’.

Commenting on the findings, Associate Professor Jan Radford said previous research suggested continuity of care had benefits for blood pressure and blood glucose control, and patient satisfaction, but it was great to see similar benefits for patient mortality.

‘The [information] that clinicians hold in their head is really important, and the relationship of trust they can build up with patients is all very therapeutic,’ said Professor Radford, Associate Professor of General Practice at the Launceston Clinical School.

She told Medicine Today that appointment systems in most medical practices are set up to encourage continuity of care for patients with chronic health problems, but some patients do not understand the potential benefits of sticking with the same doctor.

‘This research should add weight to practices designing their systems of patient care to overcome this lack of patient understanding,’ she said. ‘The challenge in practices remains to offer continuity of care to a patient with an acute problem, including those who have background chronic issues.’
BMJ Open 2018; doi: 10.1136/bmjopen-2017-021161.