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

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Primary medical care continuity and patient mortality: a systematic review

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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included, from MEDLINE, Embase, PsycINFO, OpenGrey, and the library catalogue of the New York Academy of Medicine for unpublished studies.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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Contribution of Primary Care to Health Systems and Health
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Additional file 1 of Where the joy comes from: a qualitative exploration of deep GP-patient relationships
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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: Baker, Richard
Freeman, George K
Haggerty, Jeannie L
Nockels, Keith H
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: 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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Primary medical care continuity and patient mortality: a systematic review

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