Patients' perceptions and experiences of 'continuity of care' in diabetes.
BACKGROUND
'Continuity of care' is an important aspect of quality. However, definitions are broad and existing models of continuity are not well grounded in empirical data.


OBJECTIVE
To identify patients' experiences and values with respect to continuity in diabetes care.


METHODS
In-depth semi-structured interviews with 25 type 2 diabetic patients from 14 general practices in two inner London boroughs. Interviews were transcribed and responses analysed thematically and grouped into dimensions of continuity of care.


RESULTS
Patients' accounts identified aspects of care they valued that were consistent with four dimensions of experienced continuity of care. These were receiving regular reviews with clinical testing and provision of advice over time (longitudinal continuity); having a relationship with a usual care provider who knew and understood them, was concerned and interested, and took time to listen and explain (relational continuity); flexibility of service provision in response to changing needs or situations (flexible continuity); and consistency and co-ordination between different members of staff, and between hospital and general practice or community settings (team and cross-boundary continuity). Problems of a lack of experienced continuity mainly occurred at transitions between sites of care, between providers, or with major changes in patients' needs.


CONCLUSIONS
The study develops a patient-based framework for assessing continuity of care in chronic disease management and identifies key transition points with problems of lack of continuity. It is important that service 'redesign' and developments in vertically integrated services for chronic disease management take account of impacts on patients' experience of continuity of care.
Naithani
Smriti
S
Research Associate, Division of Health and Social Care Research, King's College, London, UK.
Gulliford
Martin
M
Morgan
Myfanwy
M