Current evidence on the impact of continuity of care.

PURPOSE OF REVIEW

A core attribute of primary care, continuity of care, is usually viewed as the relationship between a patient and a single practitioner that extends beyond episodes of illness or care for a specific disease and is ongoing over time. The latest evidence of the effectiveness of continuity of care on outcomes for children and adolescents will be presented and placed into the context of prior literature.

RECENT FINDINGS

Despite numerous changes in health care delivery systems, recent studies found that clinician continuity continues to be highly valued by patients and their families. From January 1, 2002 to July 1, 2004, five new studies on physician continuity also assessed pediatric outcomes. These studies found an association between physician continuity and lower emergency department use and costs, better coordination of care, and greater patient and parent satisfaction with care. Two new studies on continuity with a primary care practice found that it was associated with higher receipt of recommended developmental, dental, and nutritional advice, as well as up-to-date immunization coverage.

SUMMARY

Organizational approaches to maximizing access while maintaining continuity require further development. Efforts to restructure provider reimbursement and information systems need to move from single encounter-based systems toward an emphasis on the provision of care over time, to reward and facilitate continuity of care and the positive patient outcomes with which it is associated.