Tzortziou Brown Victoria, Park Sophie, Mahtani Kamal Ram, Taylor Stephanie, Owen-Boukra Emily C, Taylor Jonathan, Richards Owen, Begum Sultana, Wong Geoff
Wolfson Institute of Population Health, Queen Mary University of London, London, England, UK
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England, UK.
BMJ Open. 2025 Sep 9;15(9):e104081. doi: 10.1136/bmjopen-2025-104081.
Relational continuity of care (RCC) refers to the sustained therapeutic relationship between a patient and a clinician, which fosters trust, enhances communication and facilitates the accumulation of knowledge about the patient. RCC is associated with enhanced patient outcomes, reduced hospital admissions, lower mortality rates, decreased healthcare costs and improved patient experience. Despite these benefits, reorganisations within the NHS and workforce challenges have led to an increased reliance on multidisciplinary and part-time working, resulting in fragmented care and a decline in RCC. Our study aims to explore who needs RCC, under what circumstances, to what extent and why, with the goal of informing optimal implementation strategies.
We will conduct a realist review to develop an evidence-based programme theory explaining the mechanisms underlying RCC, the populations that benefit most, the contextual factors influencing RCC and effective care models. Following Pawson's five iterative stages, we will: (1) Locate existing theories, (2) Search for relevant evidence, (3) Select appropriate articles, (4) Extract and organise data and (5) Synthesise findings to draw conclusions. A stakeholder advisory group, comprising policymakers, healthcare professionals, public contributors and patients, will be engaged throughout the process. We will adhere to Realist And Meta-narrative Evidence Synthesis: Evolving Standards (RAMESES) for realist reviews to ensure methodological rigor.
Our findings will inform practical, evidence-based recommendations for optimising RCC within general practice. Outputs will include peer-reviewed publications, conference presentations, plain English summaries, social media infographics, a short video and end-of-study events. Collaborations with stakeholders and public involvement will ensure both accessibility and impact. Ethical approval is not required for this review.
连续性关系照护（RCC）是指患者与临床医生之间持续的治疗关系，这种关系能促进信任、加强沟通并有助于积累患者的相关知识。RCC与改善患者预后、减少住院次数、降低死亡率、降低医疗成本及改善患者体验相关。尽管有这些益处，但英国国家医疗服务体系（NHS）内部的重组以及劳动力方面的挑战导致对多学科和兼职工作的依赖增加，从而造成护理碎片化以及RCC的下降。我们的研究旨在探讨谁需要RCC、在何种情况下、程度如何以及原因是什么，目的是为优化实施策略提供依据。
我们将进行一项实证性综述，以建立一个基于证据的项目理论，解释RCC背后的机制、最受益的人群、影响RCC的背景因素以及有效的照护模式。遵循帕森的五个迭代阶段，我们将：（1）查找现有理论，（2）搜索相关证据，（3）选择合适的文章，（4）提取并整理数据，（5）综合研究结果以得出结论。一个由政策制定者、医疗专业人员、公众贡献者和患者组成的利益相关者咨询小组将全程参与。我们将遵循实证性综述的《实证性与元叙事证据综合：不断发展的标准》（RAMESES）以确保方法的严谨性。
我们的研究结果将为在全科医疗中优化RCC提供基于证据的实用建议。产出将包括同行评审的出版物、会议报告、通俗易懂的英文摘要、社交媒体信息图表、一个短视频以及研究结束活动。与利益相关者的合作及公众参与将确保研究结果易于获取且具有影响力。本综述无需伦理批准。
