Goff Mhorag, Hindi Ali, Hammond Jonathan, Jacobs Sally
University of Manchester, Manchester, UK.
BMC Prim Care. 2025 Jul 2;26(1):202. doi: 10.1186/s12875-025-02860-8.
In recent years there has been a policy drive in the UK to improve patients' access to appointments in primary care. However, the focus on timely access could undermine continuity of care. This paper aims to investigate how continuity of care and access to care are interrelated and their relative importance for patients and healthcare professionals.
A systematic review was conducted using six academic databases (EMBASE, PubMed, Scopus, Web of Science, CINAHL and PsycINFO). Reference lists of included studies and Google Scholar were searched for additional papers. Included were peer-reviewed journal articles in English based on studies in primary care settings from any country, publication date and study design, based on data from any stakeholders. Conference abstracts, opinion papers, reports and literature reviews, studies in secondary or tertiary care or continuity between healthcare settings and studies about development of instruments to measure continuity of care or examining outcomes only were excluded. Fifty-six papers were identified for inclusion in the review. Studies presented differing perspectives on continuity and access, conceptualisations of access and continuity, and, measures used. We conducted thematic analysis of the literature and used Haggerty et al.'s (2003) conceptualization of continuity and Boyle et al.'s (2020) conceptualization of access to synthesise the data.
Themes arising were: system-level, practice-level and patient-level factors that influence access and continuity of care, what is important to patients, and how providers can support access and continuity of care. We found that 'choice of access' has the strongest relationship with relational continuity, however, 'physical access', or the ability to get and 'attend' an appointment, supersedes other dimensions of access as necessary but not sufficient for continuity of care.
Our synthesis provides evidence that experiencing continuity depend on the combination of patients' demographic characteristics and health conditions, with situational circumstances, including characteristics of the health system and provider, which are more or less changeable. We propose a theoretical framing of the relationships between the dimensions of access and continuity. It can support policymakers and providers in understanding how to balance providing both access and continuity for patients.
近年来，英国推行了一项政策，旨在改善患者获得基层医疗预约服务的机会。然而，对及时就诊的关注可能会破坏医疗服务的连续性。本文旨在研究医疗服务的连续性和可及性是如何相互关联的，以及它们对患者和医疗专业人员的相对重要性。
使用六个学术数据库（EMBASE、PubMed、Scopus、Web of Science、CINAHL和PsycINFO）进行了系统综述。还搜索了纳入研究的参考文献列表和谷歌学术以查找其他论文。纳入的是基于任何国家基层医疗环境研究、出版日期和研究设计的英文同行评审期刊文章，数据来自任何利益相关者。会议摘要、观点论文、报告和文献综述、二级或三级医疗研究或医疗环境之间的连续性研究以及仅关于测量医疗服务连续性工具的开发或仅检查结果的研究均被排除。共确定了56篇论文纳入综述。这些研究在连续性和可及性、可及性和连续性的概念化以及所使用的测量方法上呈现出不同的观点。我们对文献进行了主题分析，并使用哈格蒂等人（2003年）对连续性的概念化以及博伊尔等人（2020年）对可及性的概念化来综合数据。
出现的主题包括：影响医疗服务可及性和连续性的系统层面、实践层面和患者层面因素，对患者重要的因素，以及提供者如何支持医疗服务的可及性和连续性。我们发现“可及性选择”与关系连续性的关系最为密切，然而，“实际可及性”，即获得并“参加”预约的能力，在必要时取代了可及性的其他维度，但对于医疗服务的连续性来说并不充分。
我们的综合分析提供了证据，表明体验到连续性取决于患者的人口统计学特征和健康状况与情境因素的结合，这些情境因素包括卫生系统和提供者的特征，它们或多或少是可变的。我们提出了一个关于可及性和连续性维度之间关系的理论框架。它可以支持政策制定者和提供者理解如何为患者平衡提供可及性和连续性。
