St Leonard's Practice, Exeter, UK.
Medical School, University of Exeter, Exeter, UK.
BMJ Open. 2018 Jun 28;8(6):e021161. doi: 10.1136/bmjopen-2017-021161.
Continuity of care is a long-standing feature of healthcare, especially of general practice. It is associated with increased patient satisfaction, increased take-up of health promotion, greater adherence to medical advice and decreased use of hospital services. This review aims to examine whether there is a relationship between the receipt of continuity of doctor care and mortality.
Systematic review without meta-analysis.
MEDLINE, Embase and the Web of Science, from 1996 to 2017.
Peer-reviewed primary research articles, published in English which reported measured continuity of care received by patients from any kind of doctor, in any setting, in any country, related to measured mortality of those patients.
Of the 726 articles identified in searches, 22 fulfilled the eligibility criteria. The studies were all cohort or cross-sectional and most adjusted for multiple potential confounding factors. These studies came from nine countries with very different cultures and health systems. We found such heterogeneity of continuity and mortality measurement methods and time frames that it was not possible to combine the results of studies. However, 18 (81.8%) high-quality studies reported statistically significant reductions in mortality, with increased continuity of care. 16 of these were with all-cause mortality. Three others showed no association and one demonstrated mixed results. These significant protective effects occurred with both generalist and specialist doctors.
This first systematic review reveals that increased continuity of care by doctors is associated with lower mortality rates. Although all the evidence is observational, patients across cultural boundaries appear to benefit from continuity of care with both generalist and specialist doctors. Many of these articles called for continuity to be given a higher priority in healthcare planning. Despite substantial, successive, technical advances in medicine, interpersonal factors remain important.
CRD42016042091.
医患连续性是医疗保健的一个长期特征，尤其是在全科医疗中。它与患者满意度的提高、健康促进的增加、对医嘱的更高依从性以及医院服务的减少有关。本综述旨在研究接受医生连续性护理与死亡率之间是否存在关联。
系统综述，无荟萃分析。
1996 年至 2017 年，MEDLINE、Embase 和 Web of Science。
同行评议的原始研究文章，以英文发表，报告了患者从任何类型的医生那里接受的任何类型的连续性护理，无论设置如何，无论国家如何，与这些患者的死亡率相关。
在搜索中确定了 726 篇文章，其中 22 篇符合入选标准。这些研究都是队列或横断面研究，大多数都调整了多个潜在的混杂因素。这些研究来自九个具有非常不同文化和卫生系统的国家。我们发现连续性和死亡率测量方法以及时间框架存在如此大的异质性，以至于无法合并研究结果。然而，18 项（81.8%）高质量的研究报告称，连续性增加与死亡率降低具有统计学意义。其中 16 项是全因死亡率。另外三项没有关联，一项则显示出混合结果。这些显著的保护作用发生在全科医生和专科医生身上。
这是第一项系统综述，表明医生提供的连续性护理增加与死亡率降低相关。尽管所有证据都是观察性的，但来自不同文化背景的患者似乎都从全科医生和专科医生的连续性护理中受益。许多文章呼吁在医疗保健规划中更加重视连续性。尽管医学在技术上取得了重大、连续的进步，但人际因素仍然很重要。
PROSPERO 注册号：CRD42016042091。
