Continuity can be places, not just people

Returning to the same practice time and again can have similar health benefits to having a regular doctor, research suggests

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Returning to the same practice time and again can have similar health benefits to having a regular doctor, research suggests.

A study by Sydney GP Dr Michael Wright, presented at GP18 in the Gold Coast earlier this month, showed attending the same GP practice was just as valuable as seeing the same doctor when it came to getting timely pap smear tests.

The study drew on data from the Australian Longitudinal Study of Women’s Health, which surveyed over 58,000 women aged 18-23, 45-50 and 70-75 when the study began in 1996.

The women surveyed were asked whether they had a regular GP, a usual GP clinic, or neither.

Dr Wright mixed this survey data with Medicare data about pap smear tests to determine whether continuity of care at a practice or personal level was associated with improvements.

He used the amount of time that had passed between pap tests as a proxy for quality of care. Dr Wright found that women who visited the same GP clinic, but who did not have a regular doctor, returned two months sooner for an outstanding pap smear test than women who had neither a regular GP nor a regular GP practice.

For women who had a regular GP, this time difference was 1.75 months.

“We find few differences between personal and site continuity of care. They both seem to make a difference,” Dr Wright said.

Continuity of care is traditionally defined as repeated contact between a patient and a doctor. This kind of doctor-patient relationship has been shown to reduce mortality, increase patient satisfaction and decrease hospitalisation.

But the realities of modern general practice made this kind of relationship harder to maintain, Dr Wright said. “There are obvious limitations to scheduling all patient consultations with the same doctor, particularly with many GPs working part-time,” he said.

These days, Australian GPs tend to work fewer hours in large multidisciplinary practices, and subspecialisation has led to greater care fragmentation.

“These demographic and workforce trends make it more difficult to provide one-to-one continuity of care for all patients,” Dr Wright said. Around 90% of Australian patients have a usual general practice, but about a quarter of patients present to multiple practices each year.

In a paper published in the Australian Journal of General Practice this month, Dr Wright proposed strategies to promote site-level continuity of care.

“A first step may be to encourage all patients to identify a regular GP and practice,” he wrote.

“A more formal approach would be to encourage voluntary patient enrolment with practices, as recommended in the RACGP’s, Vision for General Practice and a Sustainable Health System, and by the federal government’s Primary Health Care Advisory Group in 2016.”

Asking patients about their preferred or usual GP would empower GPs to target holistic long-term care and preventive care appropriately, according to Dr Wright.