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Primary medical care continuity and patient mortality: a systematic review
Open accessAbstract
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included, from MEDLINE, Embase, PsycINFO, OpenGrey, and the library catalogue of the New York Academy of Medicine for unpublished studies.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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“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]
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In the citing paper
“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]
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Metadata
- 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)
- Venue
- British Journal of General Practice
- Published
- 2020-08-10
- Volume
- 70
- Issue
- 698
- Pages
- e600-e611
- ISSN
- 0960-1643 (ISSN-L)
- 1478-5242
- 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
- bronze
- doi.org
- 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 › Medicine › Family Practice › Primary Care and Health Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Systems and Technology
- Health Sciences › Nursing › Leadership and Management › 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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