[Gordon R. Freeman and Phyllis J. Freeman] Stonehenge Archeology
Continuity of Care Lessons from two Major Research Programs in UK and Canada 1999-2006 George...
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![Page 1: Continuity of Care Lessons from two Major Research Programs in UK and Canada 1999-2006 George Freeman Emeritus Professor of General Practice.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649e435503460f94b35bf0/html5/thumbnails/1.jpg)
Continuity of Care Lessons
from two Major Research Programs in
UK and Canada 1999-2006George Freeman
Emeritus Professor of General Practice
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research team
George Freeman, Maria Woloshynowych, Josip Car
– Imperial College London
Jeannie Haggerty – University of Sherbrooke, Quebec, Canada
Bruce Guthrie – University of Dundee
Richard Baker – University of Leicester
Mary Boulton – Oxford Brookes University
consultant
Ewan Ferlie - Royal Holloway, University of London
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international expert advisers
USA
Dmitri Christakis Seattle
John Saultz Portland
Barbara Starfield Baltimore
Canada
Carol Adair Calgary
Norway
Per Hjortdahl Oslo
Netherlands
Henk Schers Nijmegen
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why continuity?
1. top priority in SDO’s 1999 start up listening exercise
2. scoping study3. six major studies 2001-7
– all with strong user perspective
http://www.sdo.nihr.ac.uk/cpcontinuity.html
The Service Delivery and Organisation Programme is part of the National Institute for Health Research
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UK - six long term projects
four diseasesdiabetes community
cancer hospital
stroke hospital
severe mental illnesscommunity
generalprimary care
community
organizational cross boundary study young people with learning disability communityolder people with a stroke community
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what we did
• standardised data collection – site visits
– protocols, reports, presentations, publications
• draft report reviewed by– expert advisors
– project leaders
• common analytic framework– based on Canadian programme review - Haggerty
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Canada - 34 projects
• wider variety of settings/methods
• findings match and extend UK programme
• intervention trials for severe mental illness
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what is continuity?
two essential elements care of – an individual patient – delivered over time
three continuity types
Informational - timely appropriate information
Management – co-ordination between providers
Relationship - ongoing therapeutic relationship between a patient and one or more providers
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lessons learned - 1
• all continuity types link with greater satisfaction
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Our earliest experience of sickness is usually in a family context. We learn how
to be sick within the family
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lessons learned - 2
• all continuity types link with greater satisfaction
• most users want more involvement & responsibility
• vulnerable minority need help
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Our earliest experience of sickness is usually in a family context. We learn how
to be sick within the family
![Page 13: Continuity of Care Lessons from two Major Research Programs in UK and Canada 1999-2006 George Freeman Emeritus Professor of General Practice.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649e435503460f94b35bf0/html5/thumbnails/13.jpg)
lessons learned - 3
• all continuity types link with greater satisfaction
• most users want more involvement & responsibility
• vulnerable minority need help
• the access trade-off
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advanced medical home
all types of continuity offered
relationship continuity is key feature
- each patient has an ongoing relationship with
a personal physician
- continuous and comprehensive care
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the access trade-off - how long to wait?
to see
• physician rather than nurse
• someone you know & trust
• someone with access to full medical history
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how many extra days to wait?
vignette
minor new routineto see familiar uncertain check-up
doctor 1.0 3.5 3.5
known &trusted 0.9 2.4 4.2
full medicalhistory 1.6 3.9 7.8
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primary care findings
patients
• are well aware of clash between access and relationship continuity
• have clear views on when they need relationship continuity
• expect good informational continuity
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Sick elderly woman living alone
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overall lessons
• patient-centred care is fundamental
– most users want more involvement
– more vulnerable need help
• which type of continuity?
– Relationship, Informational, Management
• give specific priority to relationship as well as
to informational and management
continuity of care when reorganising services
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outstanding questions
Management and Informational continuity are almost self-evident goods
• how to deliver the goods?case for Relationship continuity is less clear• how to measure it and reward it?• more about trade-offs with
rapid accessspecialist expertise
• intervention trials needed
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thank you for your attention!
questions?
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primary care findings - 2
• patients value relationship continuity more
if they are older, iller or vulnerable
• some patients get less of what they want– non-white
– socially isolated or disadvantaged
– in full time work