Seeing the same doctor over time has been linked to a variety of benefits for patients, including improved care, communication and trust, but new research suggests that it could also save lives.
In what is said to be the first systematic review of how continuity of care is related to risk of dying, UK-based researchers from St Leonard’s Practice in Exeter and the University of Exeter Medical School analysed all available studies on the topic.
The 22 different studies included in the analysis collected data from nine different countries with diverse healthcare systems and cultures: Canada, Croatia, France, Israel, the Netherlands, South Korea, Taiwan, the United States and the UK. Nine of the studies examined continuity with a family physician, primary care physician or general practitioner, three investigated continuity with specialists only and ten looked at continuity with doctors of any kind.
The results of the analysis, published on Thursday in the journal BMJ Open, showed that there were fewer deaths among patients who saw the same doctor over time. 18 of the studies, or 82%, showed that consistently seeing the same doctor is linked to significantly lower rates of mortality compared to patients without continuity of care. Of the remaining four studies, three found no association and one revealed mixed results.
“Continuity of care happens when a patient and a doctor see each other repeatedly and get to know each other,” Philip Evans, a professor at the University of Exeter Medical School who worked on the study, said in a press release. “This leads to better communication, patient satisfaction, adherence to medical advice and much lower use of hospital services.”
In their review, the authors concluded: “Although all the evidence is observational, patients across cultural boundaries appear to benefit from continuity of care with both generalist and specialist doctors.” The team argued that “interpersonal factors remain important” even as the field of medicine experiences “substantial, successive, technical advances.”
However, the researchers said patients who see different doctors should not be too concerned.
“That is inevitable in some health facilities,” study co-author Sir Denis Pereira Gray, emeritus professor at the University of Exeter and former president of the UK’s Royal College of General Practitioners, told Newsweek. “They should, however, as individuals and in patient groups, steadily press for arrangements that provide more continuity of care.”
The team also acknowledged the study’s limitations and noted that the observed reduction in mortality could be due to factors other than seeing the same doctor. The Guardian points out that many studies included in the analysis did not recruit patients and then follow them over time, but rather looked retrospectively at patient records. Additionally, some of the studies did not take a variety of other important factors into account, including age, sex, socioeconomic status and habits such as smoking.
The Guardian also noted that more significant health problems could require an individual to see different doctors, as well as increase the risk of death in these patients.
Chris Salisbury, a professor at the University of Bristol who was not involved in the research, told The Guardian that although continuity of care is important, factors such as worsening illness or more severe health problems in patients, can not be entirely eliminated as a possible cause of the increased mortality rates.
Despite the uncertainty about the results, experts agreed that continuity of care provides patients with many benefits, including trust, satisfaction and adherence to medical advice.