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Continuity of care with doctors—a matter of life and death? A systematic review of continuity of care and mortality

Denis J Pereira Gray1, Kate Sidaway-Lee1, Eleanor White1,2, Angus Thorne1,3, Philip H Evans1,2

Abstract

Objective Continuity of care is a long-standing feature of healthcare, especially of general practice. It is associated with increased patient satisfaction, increased take-up of health promotion, greater adherence to medical advice and decreased use of hospital services. This review aims to examine whether there is a relationship between the receipt of continuity of doctor care and mortality.

Design Systematic review without meta-analysis.

Data sources MEDLINE, Embase and the Web of Science, from 1996 to 2017.

Eligibility criteria for selecting studies Peer-reviewed primary research articles, published in English which reported measured continuity of care received by patients from any kind of doctor, in any setting, in any country, related to measured mortality of those patients.

Results Of the 726 articles identified in searches, 22 fulfilled the eligibility criteria. The studies were all cohort or cross-sectional and most adjusted for multiple potential confounding factors. These studies came from nine countries with very different cultures and health systems. We found such heterogeneity of continuity and mortality measurement methods and time frames that it was not possible to combine the results of studies. However, 18 (81.8%) high-quality studies reported statistically significant reductions in mortality, with increased continuity of care. 16 of these were with all-cause mortality. Three others showed no association and one demonstrated mixed results. These significant protective effects occurred with both generalist and specialist doctors.

Conclusions This first systematic review reveals that increased continuity of care by doctors is associated with lower mortality rates. Although all the evidence is observational, patients across cultural boundaries appear to benefit from continuity of care with both generalist and specialist doctors. Many of these articles called for continuity to be given a higher priority in healthcare planning. Despite substantial, successive, technical advances in medicine, interpersonal factors remain important.

Argirios Argiriou:
Μεταφράζω από τα Σουηδικά στα Αγγλικά ένα πολύ εύστοχο σχόλιο κατά την γνώμη μου μιας έμπειρης Σουηδέζας Γενικής Ιατρού, της Charlotte Barouma, σε σχετικό Ιατρικό άρθρο:

Kontinuitet är viktigare än kompetens tycker jag - om man är ansvarig för sina patienter så skaffar man den kunskap som behövs. Brist på kontinuitet kan leda till motsatsen.......

I think that Continuity is more important than competence, - if you are responsible for your patients, you get the knowledge you need. Lack of continuity can lead to the opposite .......

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Argirios Argiriou:
Σχετική βιβλιογραφία:

Engström SG, André M, Arvidsson E, et al. Personal GP continuity improves healthcare outcomes in primary care populations: a systematic review. Br J Gen Pract. 2025;75(757):e518-25.

Bradford Hill A (editor). The environment and disease: association or causation? Proc R Soc Med. 1965;58:295-300.

Baker R, Freeman GK, Haggerty JL, et al. Primary medical care continuity and patient mortality: a systematic review. Br J Gen Pract. 2020;70(698):e600-11.

Barker I, Steventon A, Deeny SR. Association between continuity of care in general practice and hospital admissions for ambulatory care sensitive conditions: cross sectional study of routinely collected, person level data. BMJ. 2017;356:j84.

Pereira Gray DJ, Sidaway-Lee K, White E, et al. Continuity of care with doctors – a matter of life and death? A systematic review of continuity of care and mortality. BMJ Open. 2018;8(6):e021161.

Fast läkarkontakt i primärvården 2024. Behov och tillgång ur befolkningens perspektiv. Stockholm: Myndigheten för vård- och omsorgsanalys; 2024. Pm 2024:5.

Vården ur befolkningens perspektiv. International Health Policy Survey (IHP) 2023. Stockholm: Myndigheten för vård- och omsorgsanalys; 2024. Pm 2024:3.
     
Omtag för omställning. Utvärdering av omställningen till en god och nära vård: slutrapport. Stockholm: Myndigheten för vård- och omsorgsanalys; 2025. Rapport 2025:1.

Sveriges Kommuner och regioner (SKR). Primärvårdskvalitet. Kontinuitet. 24 mar 2025.

Bice TW, Boxerman SB. A quantitative measure of continuity of care. Med Care. 1977;15(4):347-9.

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