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Cited by 91Primary Care and Health OutcomesHealthcare Systems and TechnologyPatient Satisfaction in Healthcare

Predictors of relational continuity in primary care: patient, provider and practice factors

Open access
Kristjansson, Elizabeth, Hogg, William, Dahrouge, Simone, Tuna, Meltem, Mayo-Bruinsma, Liesha, Gebremichael, Goshu·2013·BMC Family Practice
DOI 10.1186/1471-2296-14-72PMC PMC3688290
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Abstract

BACKGROUND: Continuity is a fundamental tenet of primary care, and highly valued by patients; it may also improve patient outcomes and lower cost of health care. It is thus important to investigate factors that predict higher continuity. However, to date, little is known about the factors that contribute to continuity. The purpose of this study was to analyse practice, provider and patient predictors of continuity of care in a large sample of primary care practices in Ontario, Canada. Another goal was to assess whether there was a difference in the continuity of care provided by different models of primary care. METHODS: This study is part of the larger a cross-sectional study of 137 primary care practices, their providers and patients. Several performance measures were evaluated; this paper focuses on relational continuity. Four items from the Primary Care Assessment Tool were used to assess relational continuity from the patient's perspective. RESULTS: Multilevel modeling revealed several patient factors that predicted continuity. Older patients and those with chronic disease reported higher continuity, while those who lived in rural areas, had higher education, poorer mental health status, no regular provider, and who were employed reported lower continuity. Providers with more years since graduation had higher patient-reported continuity. Several practice factors predicted lower continuity: number of MDs, nurses, opening on weekends, and having 24 hours a week or less on-call. Analyses that compared continuity across models showed that, in general, Health Service Organizations had better continuity than other models, even when adjusting for patient demographics. CONCLUSIONS: Some patients with greater health needs experience greater continuity of care. However, the lower continuity reported by those with mental health issues and those who live in rural areas is concerning. Furthermore, our finding that smaller practices have higher continuity suggests that physicians and policy makers need to consider the fact that 'bigger is not always necessarily better'.

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  • Younger patients, male patients, patients from rural areas and patients with fewer chronic diseases have been shown to have lower relational continuity.

    “Younger patients, male patients, patients from rural areas and patients with fewer chronic diseases have been shown to have lower relational continuity [94, 95].”

    From Improved access to and continuity of primary care after attachment to a family physician: longitudinal cohort study on centralized waiting lists for unattached patients in Quebec, Canada (2022) · cites this paper as [94]

    The Results (Question one; page unavailable) report greater continuity among older patients and patients with more chronic diseases, and lower continuity as rurality increases. The patient-sex association in Table 1 (Results, Descriptive and bivariate analyses; page unavailable) has a confidence interval crossing zero, so this paper does not establish lower continuity among male patients. (LLM, conf=0.88)

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Authors
Kristjansson, E., Hogg, W., Dahrouge, S., Tuna, M., Mayo-Bruinsma, L., & Gebremichael, G.
Affiliations
  • University of Ottawa (CA)
  • Bruyère (CA)
  • Environment and Climate Change Canada (CA)
Corresponding author
Kristjansson, Elizabeth
ORCID
Venue
BMC Family Practice
Publisher
Springer Science and Business Media LLC
Published
2013-05-31
Volume
14
Issue
1
Pages
72-72
ISSN
1471-2296 (ISSN-L)
DOI
10.1186/1471-2296-14-72
PMC
PMC3688290
OpenAlex
W2074443220
Cited by
91
References
47
Citations by year
2026: 6 · 2025: 3 · 2024: 6 · 2023: 11 · 2022: 11 · 2021: 5 · 2020: 9 · 2019: 11 · 2018: 7 · 2017: 7 · 2016: 6 · 2015: 3 · 2014: 5 · 2013: 1
FWCI
9.01
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Family Practice (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • uO Research (University of Ottawa) (submittedVersion, cc-by)
  • uO Research (University of Ottawa) (submittedVersion, public-domain)
Topics
  • Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
  • Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Healthcare Systems and Technology
  • Health Sciences › Health Professions › General Health Professions › Patient Satisfaction in Healthcare
Keywords
relational continuity, continuity of care, primary care, patient factors, provider factors, health care organization, chronic disease, rural residence, mental health, practice size, Primary Care Assessment Tool, Ontario
MeSH terms
Chronic Disease, Continuity of Patient Care, Cross-Sectional Studies, Female, Health Status Indicators, Humans, Male, Ontario, Physician-Patient Relations, Physicians, Family, Primary Health Care, Quality Assurance, Health Care, Rural Population, Socioeconomic Factors

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