Death Rates May Be Lower When Patients See the Same Doctor

Peter Russell

June 29, 2018

Lower death rates occur when patients see the same doctor over time, new research has concluded.

The authors of a study in BMJ Open said they carried out the first systematic review of the relationship between mortality and continuity of care.

Rapid advances in medicine during the last 200 years, from germ theory to sequencing the human genome, have generated deeper understanding of disease prevention and treatment but have mostly been related to physical factors, researchers say.

'Human Aspects of Medical Care Has Lagged'

Sir Denis Pereira Gray, who led the investigation, said: "There have been huge advances in technology – and they've had a lot of publicity – and one can argue that the human side of medicine has been a bit neglected."

Sir Denis, a former president of the Royal College of General Practitioners (RCGP), said the advantages of personal care have been established. "It's been shown that it improves patient satisfaction, it improves the likelihood of a patient following medical advice, it improves the uptake of personal preventive medicine, and it reduces unnecessary admissions to hospital significantly."

The study, a collaboration between St Leonard's Practice in Exeter and the University of Exeter Medical School, investigated whether higher levels of continuity of care, in any setting, with any patient group, was associated with changed mortality.
 

Lower Death Rates

The researchers analysed 22 eligible English language studies published over the previous 21 years.

In 18 of the studies, higher levels of continuity of care were associated with lower mortality rates. The remaining four studies showed either no association with lower death rates or mixed results.

"The majority of the studies reported all-cause mortality but some of them reported disease-specific mortality like deaths from cardiovascular disease," Sir Denis said.

Continuity of care in the studies included that received from primary care doctors as well as specialists in nine countries across six continents, suggestive that the effect was not limited to one branch of medicine or health system.

An Issue Affecting the Quality of Medical Care

Continuity of care was associated with patients perceiving that the doctor was more responsive, the authors concluded, encouraging patients to disclose more and allowing medical interventions to be more effectively tailored to individual needs.

According to Sir Dennis, there were important lessons that healthcare systems could learn from the findings. "First of all, they're not patient oriented, so in other words giving the patient the doctor they want to see is seen as a convenience, whereas now I think – after this result – it's a matter of quality of medical care," he told Medscape News UK. 

"Patients communicate better with some doctors than others and so the personal relationship has been undervalued and in fact almost disregarded in some settings – so I hope it could have quite profound implications in reordering people's priorities."
 

'Huge Challenge'

Commenting on the research, Professor Kamila Hawthorne, vice chair, professional development, of the Royal College of GPs, said: "Delivering continuity of care for patients is something GPs strive to do – we know our patients want and value it, as GPs do, and we know that it is particularly beneficial for patients with chronic conditions, long-term mental health issues, and complex needs.

"But general practice is currently facing intense resource and workforce pressures, which is making it increasingly difficult for patients to access our services and unfortunately, waiting to see 'their' GP means patients may have to wait even longer for an appointment. Some are willing to do this but often they cannot wait and seeing another GP or health professional in the practice team can speed up access in some situations.

"Many GP practices across the country are using innovative approaches to retaining continuity of care. For example, a patient might be assigned to a team consisting of several GPs and other healthcare professionals in the practice, all of whom will have full access to their records, allowing them to see and build trusting relationships with the whole team, not just 'their' doctor.

"Balancing continuity of care with timely access to GP services is a huge challenge for general practice, and ultimately the answer is more GPs and more resources for the profession."

Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.

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;0:e021161. doi:10.1136/ bmjopen-2017-021161. Paper.

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