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Cited by 331Primary Care and Health OutcomesHealthcare Systems and TechnologyHospital Admissions and Outcomes

Primary medical care continuity and patient mortality: a systematic review

Open access
Baker, Richard, Freeman, George K, Haggerty, Jeannie L, Bankart, M John, Nockels, Keith H·2020·British Journal of General Practice
DOI 10.3399/bjgp20x712289PMC PMC7425204
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Abstract

Background: A 2018 review into continuity of care with doctors in primary and secondary care concluded that mortality rates are lower with higher continuity of care. Aim: This association was studied further to elucidate its strength and how causative mechanisms may work, specifically in the field of primary medical care. Design and setting: Systematic review of studies published in English or French from database and source inception to July 2019. Method: Original empirical quantitative studies of any design were included, from MEDLINE, Embase, PsycINFO, OpenGrey, and the library catalogue of the New York Academy of Medicine for unpublished studies. Selected studies included patients who were seen wholly or mostly in primary care settings, and quantifiable measures of continuity and mortality. Results: Thirteen quantitative studies were identified that included either cross-sectional or retrospective cohorts with variable periods of follow-up. Twelve of these measured the effect on all-cause mortality; a statistically significant protective effect of greater care continuity was found in nine, absent in two, and in one effects ranged from increased to decreased mortality depending on the continuity measure. The remaining study found a protective association for coronary heart disease mortality. Improved clinical responsibility, physician knowledge, and patient trust were suggested as causative mechanisms, although these were not investigated. Conclusion: This review adds reduced mortality to the demonstrated benefits of there being better continuity in primary care for patients. Some patients may benefit more than others. Further studies should seek to elucidate mechanisms and those patients who are likely to benefit most. Despite mounting evidence of its broad benefit to patients, relationship continuity in primary care is in decline — decisive action is required from policymakers and practitioners to counter this.

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Crossref · 10.3399/bjgp20x712289

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  • Increased continuity of care, particularly with a family physician, is associated with decreased hospitalizations, fewer emergency visits, more preventive care, improved patient satisfaction, safer prescribing, lower rates of major adverse events and reduced mortality.

    “In addition, increased continuity of care, particularly with a family physician, is associated with decreased hospitalizations, fewer emergency visits, more preventive care, improved patient satisfaction, safer prescribing, lower rates of major adverse events and reduced mortality [11–17].”

    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 [14]

    The Introduction links primary-care continuity with lower hospitalisation and emergency-room use and improved patient satisfaction; Selected populations mentions preventive care. How this fits in reports an association with lower mortality, while noting that it varies and is not always present. The passages do not support the added claims of safer prescribing or fewer major adverse events. (LLM, conf=0.87)

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  • There is a paucity of evidence about ways of improving domiciliary midwifery care in the study setting.

    “There is however, paucity of evidence about ways of improving this care in the study setting.”

    From Enablers and barriers of domiciliary midwifery practice using the socio-ecological model: a qualitative study exploring the perspectives of students and lecturers in Uganda (2026) · cites this paper as [7]

    The Implications for research section calls for studies on how to improve continuity in primary medical care, but does not discuss domiciliary midwifery care or evidence in the citing paper’s study setting. Searches for domiciliary midwifery and home-based maternity care found no passage addressing that claim. (LLM, conf=0.76)

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Cites

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1 of the 44 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. Ridd MJ, Santos Ferreira DL, Montgomery AA, et al. Patient-doctor continuity and diagnosis of cancer: electronic medical records study in general practice. Br J Gen Pract 2015; DOI: https://doi.org/10.3399/bjgp15X684829. · DOI
  2. Palmer B, Hemmings N, Rosen R, et al. Improving access and continuity in general practice: evidence review. 2018. https://www.nuffieldtrust.org.uk/ research/improving-access-and-continuity-in-general-practice (accessed 24 Jul 2020).

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Authors
Baker, R., Freeman, G. K., Haggerty, J. L., Bankart, M. J., & Nockels, K. H.
Affiliations
  • University of Leicester (GB)
  • Imperial College London (GB)
  • McGill University (CA)
ORCID
Venue
British Journal of General Practice
Publisher
Royal College of General Practitioners
Published
2020-08-10
Volume
70
Issue
698
Pages
e600-e611
ISSN
  • 0960-1643 (ISSN-L)
  • 1478-5242
DOI
10.3399/bjgp20x712289
PMC
PMC7425204
OpenAlex
W3048946873
Cited by
331
References
44
Citations by year
2026: 60 · 2025: 57 · 2024: 79 · 2023: 48 · 2022: 42 · 2021: 37 · 2020: 8
FWCI
6.43
Type
journal article
Language
en
Open access
Locations
  • British Journal of General Practice (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Figshare (submittedVersion, cc-by)
  • Spiral (Imperial College London) (submittedVersion)
Funders
National Institute for Health and Care Research (NF-SI-0510-10025)
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 › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
Keywords
continuity of care, primary care, patient mortality, all-cause mortality, coronary heart disease mortality, relational continuity, physician knowledge, patient trust, clinical responsibility
MeSH terms
Continuity of Patient Care, Cross-Sectional Studies, Humans, Primary Health Care, Retrospective Studies, Secondary Care, Secondary Health Care

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