Beaney Thomas, Woodcock Thomas, Aylin Paul, Majeed Azeem, Clarke Jonathan
The George Institute for Global Health, Imperial College London, London
Department of Primary Care and Public Health, Imperial College London, London.
Br J Gen Pract. 2025 Jun 2. doi: 10.3399/BJGP.2024.0579.
Better continuity in primary and secondary care is linked to improved health outcomes, but it is unclear whether the sociodemographic determinants of continuity are the same in both settings and whether continuity measures in each setting are associated.
To examine the determinants of relational continuity in general practice and fragmented outpatient specialty care in people with clusters of multiple long-term conditions (LTCs) and the association between continuity in each setting.
A cohort of patients aged ≥18 years registered to general practices in England throughout 2019 and who had linked hospital outpatient records. Patients with ≥2 of 212 LTCs and with ≥3 general practice and ≥3 outpatient appointments were included.
The Continuity of Care Index (COCI) was calculated separately for visits to the same a) GP and b) outpatient specialty, and associations calculated for sociodemographic factors and number of LTCs with COCI scores. The association was also assessed between indices in each setting using univariable and multivariable fractional logit regression.
Of 1 135 903 patients, 56.3% ( = 639 489) were aged ≥60 years. Age was the strongest determinant of continuity in general practice, whereas number of LTCs was the strongest determinant in secondary care. Although statistically significant (<0.001), the relationship between the COCI in general practice and outpatients was clinically insignificant in both univariable and multivariable models.
A lack of strong association between continuity of care in general practice and outpatient settings was found. This suggests that fragmented hospital care is not mitigated by increased continuity in general practice.
初级保健和二级保健之间更好的连续性与改善健康结果相关，但尚不清楚连续性的社会人口学决定因素在两种环境中是否相同，以及每种环境中的连续性措施是否相关。
研究患有多种长期疾病（LTCs）的人群在全科医疗和门诊专科医疗中的关系连续性的决定因素，以及每种环境中连续性之间的关联。
对2019年在英格兰全科医疗注册且有相关医院门诊记录的18岁及以上患者队列进行研究。纳入患有212种LTCs中至少2种，且有至少3次全科医疗和至少3次门诊预约的患者。
分别计算同一a）全科医生和b）门诊专科就诊的连续性护理指数（COCI），并计算社会人口学因素和LTCs数量与COCI评分之间的关联。还使用单变量和多变量分数对数回归评估每种环境中指数之间的关联。
在1135903名患者中，56.3%（n = 639489）年龄≥60岁。年龄是全科医疗中连续性的最强决定因素，而LTCs数量是二级保健中连续性的最强决定因素。尽管具有统计学意义（<0.001），但在单变量和多变量模型中，全科医疗和门诊患者的COCI之间的关系在临床上均无显著意义。
发现全科医疗和门诊环境中的护理连续性之间缺乏强关联。这表明全科医疗中连续性的增加并不能缓解医院护理的碎片化。
