Marshall Tom, Scheibl Fiona, Williams Iestyn, Nirantharakumar Krishnarajah, Willis Brian H, Kasteridis Panagiotis, Sterniczuk Kamil, Chen Jinyang, Anteneh Zecharias Fetene, Greenfield Sheila
School of Health Sciences, Public Health and Epidemiology, College of Medicine and Health, University of Birmingham, Birmingham, UK
School of Health Sciences, College of Medicine and Health, University of Birmingham, Birmingham, UK.
BMJ Open. 2025 Apr 29;15(4):e088573. doi: 10.1136/bmjopen-2024-088573.
Relational continuity of care is where patients see the same clinicians over time. Evidence suggests relational continuity of care is valued by patients and clinicians and results in better health. While current National Health Service policy aims to maintain relational continuity of care, it has been declining in recent years, which may be linked to the growth in practice size, increased staff turnover, part-time working and the focus on patient access. Our research aims to develop resources to help clinicians measure, manage and improve relational continuity of care.
A mixed-methods approach in UK primary care commencing with two workshops drawing patients, clinicians and researchers together to establish an agreed approach on the measurement of continuity of care. Second, analysis of national data will provide insight into how staff turnover, part time working, practice size and funding per patient affects continuity. Third, case studies in a sample of high-performing practices will document the barriers and facilitators to the establishment and maintenance of continuity of care. Fourth, an economic analysis of resource costs and health outcomes using linked primary and secondary care data will show whether costs influence continuity for different patient groups (by age, sex, deprivation status and chronic disease status). Fifth, we will develop practical guidance for clinicians to improve continuity of care, based on the findings from each stage of the research.
The study has approval from HRA Health and Care Research Wales Research Ethics Committee (HCRW). Findings will be disseminated through peer-reviewed publications, participatory workshops, podcasts, clinical networks and academic conferences.
连续性医疗关系是指患者在一段时间内由相同的临床医生诊治。有证据表明，连续性医疗关系受到患者和临床医生的重视，并能带来更好的健康状况。虽然目前英国国家医疗服务体系的政策旨在维持连续性医疗关系，但近年来其一直在下降，这可能与诊所规模的扩大、员工流动率增加、兼职工作以及对患者就医便利性的关注有关。我们的研究旨在开发资源，以帮助临床医生衡量、管理和改善连续性医疗关系。
在英国初级医疗保健领域采用混合方法，首先举办两场研讨会，将患者、临床医生和研究人员聚集在一起，就连续性医疗的衡量方法达成一致。其次，对全国数据的分析将深入了解员工流动率、兼职工作、诊所规模和每位患者的资金投入如何影响连续性。第三，对一些高效诊所的案例研究将记录建立和维持连续性医疗的障碍与促进因素。第四，使用初级和二级医疗保健关联数据对资源成本和健康结果进行经济分析，将显示成本是否会影响不同患者群体（按年龄、性别、贫困状况和慢性病状况划分）的连续性。第五，我们将根据研究各阶段的结果，为临床医生制定改善连续性医疗的实用指南。
本研究已获得威尔士卫生与护理研究伦理委员会（HCRW）的批准。研究结果将通过同行评审出版物、参与式研讨会、播客、临床网络和学术会议进行传播。
