Continuity & Comprehensiveness of Care
Primary Care Toolkit for Family Physicians
The College of Family Physicians of Canada
Continuity of care refers to the ability of patients to access healthcare with and through the same professional care provider over time, often described as "cradle to grave ". Continuity of care is almost inseparable from comprehensiveness of care. While continuity implies the ongoing availability of one's own family physician as a trusted caregiver, comprehensiveness implies the family physician's ability to access a wide range of health services to respond to a variety of related events during a patient's lifetime. Canadians value both the continuity and comprehensiveness that family physicians provide in healthcare and neither can either exist alone.
Continuity and comprehensiveness of care has become progressively more difficult to maintain and this issue has been recognized as a major problem for patients, family physicians and governments. There are many reasons for this. For example, the increasing mobility, diversity and ethnicity of Canadian populations has led to the need for family physicians in primary care to understand both the health as well as the social wellbeing of a variety of patients in a range of healthcare settings. Other reasons include those related directly to family physicians or to patients themselves, for example the:
- Increasing knowledge base required by family physicians
- Accompanying growth of specialization, even within family medicine
- Lack of supportive infrastructures for family practice
- Fragmentation of patient care services
- Under-funding of health system resources that promote continuity and comprehensiveness
These powerful forces have combined to make access to competent, continuing, and comprehensive care more difficult for many Canadians. This difficulty is further reflected in figures describing decreasing human resources in family medicine, increasing numbers of "orphan " patients, and now evident gaps in the quality of care, especially in chronic disease management. Despite this, family physicians are the only healthcare professionals in the system that have the skills and knowledge acquired through their education, training and practice experience to provide the kind of continuity and comprehensiveness of care that Canadians value. This value is recognized in the many reports that reference the importance Canadians place on their lasting relationship with their own family physician and how this affects their assessment of healthcare quality in the rest of the system.
Continuity of care also refers to care provided 24 hours a day, 7 days a week (24/7), 365 days per year. This includes access to non-urgent or long-term care as well as acute care integrated within local or regional healthcare systems. But while patients experience significant benefits in having access to this kind of care provided by the same family physician and/or even the same family physicians in a group practice, maintaining continuity of care can sometimes be a challenge to the physicians themselves. It is now recognized that in our current environment, it may not be reasonable to assume family physicians can always guarantee continuity of care. The importance of covering their practices and making themselves available to their patients at all times must also be balanced by family physicians with its potential effects on their own personal health and wellbeing. The reality of evolving family practices is that young physicians need to find a suitable balance between family responsibilities and patient care. To do this, supportive practice arrangements must be made available so that the needs of both patients and providers can be met.
While much is made of the need for appropriate information technology and other basic infrastructure supports, continuity and comprehensiveness of care also depend on sufficient health human resources to support local family practices. Without these, communities may well be concerned about "discontinuity of care " and its effects on the health of their populations. Continuity of care implies consistency and predictability in the way patients are cared for and to be successful, health human resources other than family physicians must also be available. These include nurses, dieticians, social workers and other healthcare professionals. This infrastructure need must be brought to the attention of local, regional and provincial/territorial health authorities and governments that may not be aware of the potentially helpful roles that other professionals play in partnering with family physicians to improve patient care and the primary care system.
In the development of primary care models, governments, health authorities and physician groups have recognized the importance of emphasizing both continuity and comprehensiveness of care. Benefits to the community include:
- Reduced duplication of health services
- Improved cost-effectiveness in the health system
- Greater opportunities to deliver preventative care services and to manage chronic diseases
- Better patient perceptions of quality of care
- Reduced liability costs
- More understanding relationships between patients and providers, resulting in:
- Higher patient satisfaction
- Greater provider satisfaction
- Increased success in recruiting new family physicians