Connolly Margaret J, Weppner William G, Fortuna Robert J, Snyder Erin D
Department of Pulmonary and Critical Care Medicine, University of Rochester Medical Center, Rochester, USA.
Department of General Internal Medicine, University of Washington, Seattle, USA.
Cureus. 2022 May 20;14(5):e25167. doi: 10.7759/cureus.25167. eCollection 2022 May.
Continuity of care is an essential component of primary care, resulting in improved satisfaction, management of chronic conditions, and adherence to screening recommendations. The impact of continuity of care in teaching practices remains unclear. We performed a scoping review of the literature to understand the impact of continuity on patients and trainees in teaching practices. A systematic search was performed through PubMed to identify articles published prior to January 2020 addressing continuity of care and health outcomes in resident primary care clinic settings. A total of 543 abstracts were evaluated by paired independent reviewers. In total, 24 articles met the inclusion criteria and were abstracted by four authors. These articles included a total of 6,973 residents (median = 96, range = 9-5,000) and over 1,000,000 patients (median = 428, range = 70-1,000,000). Most publications demonstrated that higher continuity was associated with better diabetic care (71%, n = five of seven), receipt of preventive care per guidelines (60%, n = three of five), and lower costs or administrative burden of care (100%, n = three of three). A smaller proportion of publications reported a positive association between continuity and hypertension control (28%, n = two of seven). The majority of publications evaluating patient/resident satisfaction demonstrated that better continuity was associated with higher patient (67%, n = four of six) and resident (67%, n = six of nine) satisfaction. A review of the existing literature revealed that higher continuity of care in resident primary care clinics was associated with better patient health outcomes and patient/resident satisfaction. Interventions to improve continuity in training settings are needed.
连续性医疗是初级医疗的重要组成部分，可提高患者满意度、改善慢性病管理并促进筛查建议的依从性。连续性医疗在教学实践中的影响尚不清楚。我们对文献进行了范围综述，以了解连续性医疗对教学实践中患者和实习生的影响。通过PubMed进行了系统检索，以识别2020年1月之前发表的关于住院医师初级保健诊所环境中连续性医疗与健康结果的文章。由两名独立评审员对总共543篇摘要进行了评估。共有24篇文章符合纳入标准，并由四位作者进行了摘要提取。这些文章共纳入了6973名住院医师（中位数=96，范围=9-5000）和超过100万名患者（中位数=428，范围=70-1000000）。大多数出版物表明，更高的连续性与更好的糖尿病护理相关（71%，7篇中有5篇）、按照指南接受预防性护理（60%，5篇中有3篇）以及更低的护理成本或行政负担（100%，3篇中有3篇）。较小比例的出版物报道连续性与高血压控制之间存在正相关（28%，7篇中有2篇）多数评估患者/住院医师满意度的出版物表明，更好的连续性与更高的患者满意度（67%，6篇中有4篇）和住院医师满意度（67%，9篇中有6篇）相关。对现有文献的综述表明，住院医师初级保健诊所中更高的连续性医疗与更好的患者健康结果以及患者/住院医师满意度相关。需要采取干预措施来提高培训环境中的连续性。
