Continuity saves lives – here’s proof

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Research has proven what GPs have long been saying about the importance of continuity of care


Research has proven what Australian GPs have long been saying about the importance of continuity of care

A prospective study proves what Australian GPs have long known – having a regular GP saves lives.

The Dutch study, published in the British Journal of General Practice, provides the strongest evidence yet that continuity of care in general practice is associated with a lower mortality rate.

The trial of 1712 adults aged 60 or over found those with multiple GPs were 20% more likely to die over the 17-year study period than those who attended a single doctor.

On the other hand, people with the greatest continuity of care, calculated by an index based on the number of GPs consulted over time, had a significantly lower risk of death over the same period.

Almost half (43.3%) of participants had the same GP during the study.

While previous studies have shown the benefits of continuity of care, most have been based on patient experience, had a limited sample size and were of shorter duration.

“The beauty of this study is that they have used a hard outcome – which is mortality – rather than a proxy marker,” RACGP president-elect Dr Bastian Seidel told TMR.

However, despite the substantial evidence supporting continuity as a principle of general practice, Australian GPs were increasingly struggling to maintain long-term patient relationships, Dr Seidel said.

“What we are seeing in Australia, of course, is fragmentation of care,” he said.

The corporatisation of general practice, after-hours care and the aged-care sector has promoted providers that have limited contact with, and knowledge of, the patient.

“In particular, allied health practitioners, like physiotherapists and chiropractors, are actively trying to get in a space where GPs typically are. We see the same from pharmacists,” Dr Seidel said.

The implications of the study were very clear.

“What we should be doing for the Australian setting is looking at how we actually support GPs to have those long-term relationships with their patients.” The key to this was increased funding, Dr Seidel said.

“If the GP is meant to be the gatekeeper of the system then this function needs to be supported and realistically funded.”

Supporting a system that encouraged continuity of care, strong clinical governance and a gate-keeping function would deliver the same amount of care at a lower cost, or more care that achieved better clinical outcomes, he said.

The study provides further evidence supporting the Health Care Homes initiative, which focuses on the long-term care of patients.

The RACGP has been lobbying the government to accelerate the initiative, and hosted a roundtable in July, which arrived at 22 recommendations for the Federal Government to improve the Health Care Homes initiative.

British Jour of Gen Practice, Aug 2016

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