What is the importance of physician continuity in primary care?

The Importance of Physician Continuity in Primary Care

Physician continuity in primary care is a foundational element associated with improved patient satisfaction, better health outcomes, and decreased total cost of care. 1 The consistent relationship between patients and their primary care providers offers significant benefits that impact both clinical outcomes and healthcare utilization.

Benefits of Physician Continuity

• Reduced emergency department visits: High physician continuity is associated with lower emergency department utilization across all levels of patient complexity 2
• Fewer hospitalizations: Particularly for highly complex patients, seeing the same physician consistently leads to reduced hospital admissions 2
• Enhanced patient satisfaction: Interestingly, while full-time physicians provide better continuity, part-time physicians may actually achieve higher patient satisfaction scores 3
• Improved therapeutic relationship: The consistent doctor-patient relationship is highly valued by both parties 1

Current State of Continuity in Primary Care

• In some settings, such as outpatient residency clinics, patients may see their designated primary care provider only 50% or less of the time 1
• Mean baseline continuity in residency programs is approximately 55-56 out of 100 on standard continuity measures 4
• This is lower than continuity rates for independently practicing physicians 4

Types of Continuity That Matter

The research distinguishes between two important types of continuity:

1. Physician continuity: Consistently seeing the same doctor
2. Clinic continuity: Seeing different providers within the same clinic

Research shows that the best health outcomes are associated with consistently seeing one's own primary family physician or seeing a clinic partner when that physician is unavailable 2. This suggests that while individual physician continuity is ideal, clinic continuity can serve as a valuable alternative.

Challenges to Maintaining Continuity

Several factors make maintaining continuity increasingly difficult:

• Growing patient populations
• Evolving primary care workforce with more part-time providers
• Increasing burden of chronic disease 5
• Lack of empanelment of patients in residency settings 4

Strategies to Enhance Continuity

Despite these challenges, several approaches can help maintain the benefits of continuity:

• Team-based care models: Allow for shared responsibility while maintaining coordination
• Advanced access scheduling: Improves ability to match patients with their primary providers
• Block scheduling: Can enhance continuity in residency settings, though with mixed results 4
• Fostering consistent therapeutic attitudes: Even when the same doctor isn't available, an attitude to provide care consistent with a therapeutic doctor-patient relationship may deliver many continuity benefits 5

Measuring Continuity

At least 32 different measures have been used to evaluate continuity of care, with the most common being:

• Usual Provider of Care index
• Continuity for Physician formula 1, 4

Understanding these measures is essential for quality improvement efforts, though it's important to recognize that "the full complexity of continuity of care cannot be captured by formulas and indices" 1.

Clinical Implications

For optimal patient outcomes, primary care practices should prioritize scheduling patients with their designated primary care physician whenever possible. When this isn't feasible, seeing another provider within the same clinic is preferable to fragmented care across different settings 2.

Interestingly, physicians who work fewer clinical hours may provide better patient experiences despite worse continuity and access metrics 3. This suggests that quality time with patients may sometimes matter more than quantity.