title: Experienced continuity of care when patients see multiple clinicians: a qualitative metasummary.
abstract: OBJECTIVE
  Continuity of care among different clinicians refers to consistent and coherent care management and good measures are needed. We conducted a metasummary of qualitative studies of patients' experience with care to identify measurable elements that recur over a variety of contexts and health conditions as the basis for a generic measure of management continuity.
  
  
  METHODS
  From an initial list of 514 potential studies (1997-2007), 33 met our criteria of using qualitative methods and exploring patients' experiences of health care from various clinicians over time. They were coded independently. Consensus meetings minimized conceptual overlap between codes.
  
  
  RESULTS
  For patients, continuity of care is experienced as security and confidence rather than seamlessness. Coordination and information transfer between professionals are assumed until proven otherwise. Care plans help clinician coordination but are rarely discerned as such by patients. Knowing what to expect and having contingency plans provides security. Information transfer includes information given to the patient, especially to support an active role in giving and receiving information, monitoring, and self-management. Having a single trusted clinician who helps navigate the system and sees the patient as a partner undergirds the experience of continuity between clinicians.
  
  
  CONCLUSIONS
  Some dimensions of continuity, such as coordination and communication among clinicians, are perceived and best assessed indirectly by patients through failures and gaps (discontinuity). Patients experience continuity directly through receiving information, having confidence and security on the care pathway, and having a relationship with a trusted clinician who anchors continuity.
authors.affiliation: Department of Family Medicine, McGill University, Canada. Jeannie.Haggerty@mcgill.ca
authors.forename: Jeannie L
authors.initials: JL
authors.lastname: Haggerty
authors.forename: Danièle
authors.initials: D
authors.lastname: Roberge
authors.forename: George K
authors.initials: GK
authors.lastname: Freeman
authors.forename: Christine
authors.initials: C
authors.lastname: Beaulieu
mesh_terms: D000553:Ambulatory Care / Q000458:organization & administration*; D003142:Communication; D003266:Continuity of Patient Care / Q000458:organization & administration*; D019091:Critical Pathways / Q000458:organization & administration; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D018802:Patient-Centered Care / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000458:organization & administration*
keywords: continuity of patient care; patient satisfaction; patient-centered care; primary health care; process assessment (health care); qualitative research; quality of health care