Patients who see same doctor over time have lower death rates

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RoomsA ground-breaking study has concluded that patients who see the same doctor over time have lower death rates. The study, a collaboration between St Leonard’s Practice in Exeter, the University of Exeter Medical School and the University of Manchester Medical School, is the first ever systematic review of the relationship between death rates and continuity of care – seeing the same doctor over time. The study analyses all the available evidence in the field to draw its conclusions.

Sir Denis Pereira Gray, of St Leonard’s Practice, said: “Patients have long known that it matters which doctor they see and how well they can communicate with them. Until now arranging for patients to see the doctor of their choice has been considered a matter of convenience or courtesy: now it is clear it is about the quality of medical practice and is literally ‘a matter of life and death’.”

Professor Philip Evans, of the University of Exeter Medical School, said: “Continuity of care happens when a patient and a doctor see each other repeatedly and get to know each other. This leads to better communication, patient satisfaction, adherence to medical advice and much lower use of hospital services.

“As medical technology and new treatments dominate the medical news, the human aspect of medical practice has been neglected. Our study shows it is potentially life-saving and should be prioritised.”

The study found that repeated patient-doctor contact is linked to fewer deaths. The effect applied across different cultures, and was true not just for family doctors, but for specialists including psychiatrists and surgeons as well.

The review analysed the results of 22 eligible high-quality studies with varying time frames. The studies were from nine countries with very different cultures and health systems. Of those, 18 (82%) found that repeated contact with the same doctor over time meant significantly fewer deaths over the study periods compared with those without continuity.

This research was conceived and conducted in a single NHS general practice in Exeter, which has the advantage of employing its own postdoctoral research fellow. The practice team includes Professor Philip Evans who holds a leadership role in the National Institute of Health Research Clinical Research Network. The practice was pleased to build up the skills of two medical students so that they were empowered to be co-authors.

One of these medical students, Eleanor White is currently in her third year at the University of Exeter Medical School and is a former winner of the Quintiles Women in Science Award. Eleanor said: “I’m really excited that we have been able to publish our latest finding of an association of continuity of care with lower mortality. Despite continuity being a core value of General Practice, it is often overlooked in health care planning. I hope that our review encourages further research in this area so that continuity of care can be prioritised once again.”

Objective: Continuity of care is a long-standing feature of healthcare, especially of general practice. It is associated with increased patient satisfaction, increased take-up of health promotion, greater adherence to medical advice and decreased use of hospital services. This review aims to examine whether there is a relationship between the receipt of continuity of doctor care and mortality.
Design: Systematic review without meta-analysis.
Data sources: MEDLINE, Embase and the Web of Science, from 1996 to 2017.
Eligibility criteria for selecting studies: Peer-reviewed primary research articles, published in English which reported measured continuity of care received by patients from any kind of doctor, in any setting, in any country, related to measured mortality of those patients.
Results: Of the 726 articles identified in searches, 22 fulfilled the eligibility criteria. The studies were all cohort or cross-sectional and most adjusted for multiple potential confounding factors. These studies came from nine countries with very different cultures and health systems. We found such heterogeneity of continuity and mortality measurement methods and time frames that it was not possible to combine the results of studies. However, 18 (81.8%) high-quality studies reported statistically significant reductions in mortality, with increased continuity of care. 16 of these were with all-cause mortality. Three others showed no association and one demonstrated mixed results. These significant protective effects occurred with both generalist and specialist doctors.
Conclusions: This first systematic review reveals that increased continuity of care by doctors is associated with lower mortality rates. Although all the evidence is observational, patients across cultural boundaries appear to benefit from continuity of care with both generalist and specialist doctors. Many of these articles called for continuity to be given a higher priority in healthcare planning. Despite substantial, successive, technical advances in medicine, interpersonal factors remain important.

Denis J Pereira Gray, Kate Sidaway-Lee, Eleanor White, Angus Thorne, Phillip H Evans

University of Exeter material
BMJ Open abstract

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