How are different types of continuity achieved? A mixed methods longitudinal study.
BACKGROUND
In the context of developments in healthcare services that emphasise swift access to care, concern has been expressed about whether and how continuity of care, particularly interpersonal continuity, will continue to be achieved.


OBJECTIVE
To explore how patients regard and use primary care services in relation to continuity of provider and access to care, to identify factors that promote or hinder their success in achieving their preferences, and to describe what this means for how different types of continuity are achieved.


METHODS
Longitudinal, mixed methods.


METHODS
Community in London and Leicester.


METHODS
Purposive sample of 31 patients recruited from general practices, walk-in centres and direct advertising. Data collection involved in-depth interviews, consultation record booklets completed over 6 months and general practice records for the year including the study period. Data were analysed qualitatively.


RESULTS
Four patterns were identified in the way patients used primary care. These were shaped by their own preferences, by the organisation and culture of their primary care practices, and by their own and their provider's efforts to achieve their preferences. Different configurations of these factors gave rise to different types of continuity. Patients were not always able to achieve the type they wanted. Patients with apparently similar consulting patterns could experience them differently.


CONCLUSIONS
Within a programme of modernisation, policies that promote a commitment to meeting the preferences of different patients with flexibility and understanding are most likely to provide continued support for interpersonal and other types of continuity of care.
Boulton
Mary
M
School of Health & Social Care, Oxford Brookes University, Jack Straws Lane, Oxford OX3 0FL. mgboulton@brookes.ac.uk
Tarrant
Carolyn
C
Windridge
Kate
K
Baker
Richard
R
Freeman
George K
GK
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care / Q000458:organization & administration / Q000592:standards*; D005194:Family Practice / Q000458:organization & administration / Q000592:standards*; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011787:Quality of Health Care / Q000592:standards