Crucial yet sidestepped – continuity in Swedish primary care

Research problem and specific questionsEven though continuity in patient-physician relations is a key component of primary care, Swedish primary care is organized in a way that does not presuppose such relational continuity.

Patients are mainly offered formal continuity: enrollment with a certain practice or physician.This project asks the following question: What role does continuity play in Swedish primary care, and what does it imply for patients’ care utilization and health?

The project has four subquestions:What are the characteristics of patients, physicians and practices that, respectively, are offered or offer high relational continuity?

How can primary care practices lay the foundation for higher continuity?Does formal continuity with a specific physician help previously healthy patients to establish relational continuity after the onset of a chronic disease?How do disruptions of formal and relational continuity affect individuals’ care utilization and health?Little is known about factors linked with high continuity, and it is unclear if mere enrollment with a physician facilitates the establishment of continuity when the patient’s need grows.

A large literature links continuity with desirable health outcomes, but causal studies are rare.

This project contributes in all these regards.Data and method The project uses statistical methods to analyze longitudinal data from regional (Skåne) and national registers. We measure both formal continuity – enrollment – and relational continuity at consultations.

The rich background data allows us to analyze patient-, physician-, and practice-level determinants of continuity, in general as well as after the onset of a chronic condition.

To examine effects of disruptions in continuity, we will study care data of patients whose physician exits the practice.Plan for project realisationThe research team consists of three health economists, supported by a medical adviser (a general practitioner). The team has long experience of similar analyses of primary care data.

The budget mainly covers research time.Relevance Primary care is key to provide patient-centered and integrated care, but lacks funding and has to prioritize the allocation of continuous relationships.

The project will yield insights of what patients that are prioritized today, how to lay foundations for continuity, and how it matters for patients. It will also show if formal enrollment helps the establishment of continuity when it is needed the most.