Clinical Question

Is continuity of care associated with decreased mortality?

Bottom Line

Most studies in this systematic review found a protective effect of greater primary care continuity and all-cause mortality. (Level of Evidence = 2a)

Synopsis

The authors searched several databases and the gray literature to identify 13 empiric studies that reported measures of continuity and mortality in patients seen in primary care settings. All of the studies evaluated continuity of care via care-use patterns or patient report. Only two of the studies included nurse practitioners or physician assistants. The nature of the studies and their data prevented formal meta-analysis. A limitation of this review is that the studies evaluated only personal continuity (ongoing relationship with a health care professional), not informational continuity (accessibility of records) or management continuity (coordination between all groups involved in care). Twelve studies evaluated all-cause mortality, nine of which found a statistically significant lower mortality risk associated with greater continuity, two found no association, and one found that the association changed based on the measure of continuity used. Two studies found lower risks of coronary heart disease mortality with greater continuity, and one found lower mortality risks from cancer or chronic obstructive lung disease. The authors extracted potential mechanisms to explain the associations, but it is all speculation and begs the real questions: how can more primary care physicians be cultivated, and how can health care systems be encouraged to prioritize the delivery of primary care?

Study design: Systematic review

Funding source: Self-funded or unfunded

Setting: Outpatient (primary care)

Reference: 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–e611.