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Predicting declines in perceived relationship continuity using practice deprivation scores: a longitudinal study in primary care.

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journal contribution
posted on 25.05.2018, 15:09 by Louis S. Levene, Richard Baker, Nicola Walker, Christopher Williams, Andrew Wilson, John Bankart
BACKGROUND: Increased relationship continuity in primary care is associated with better health outcomes, greater patient satisfaction, and fewer hospital admissions. Greater socioeconomic deprivation is associated with lower levels of continuity, as well as poorer health outcomes. AIM: To investigate whether deprivation scores predicted variations in the decline over time of patient-perceived relationship continuity of care, after adjustment for practice organisational and population factors. DESIGN AND SETTING: An observational study in 6243 primary care practices with more than one GP, in England, using a longitudinal multilevel linear model, 2012-2017 inclusive. METHOD: Patient-perceived relationship continuity was calculated using two questions from the GP Patient Survey. The effect of deprivation on the linear slope of continuity over time was modelled, adjusting for nine confounding variables (practice population and organisational factors). Clustering of measurements within general practices was adjusted for by using a random intercepts and random slopes model. Descriptive statistics and univariable analyses were also undertaken. RESULTS: Relationship continuity declined by 27.5% between 2012 and 2017, and at all deprivation levels. Deprivation scores from 2012 did not predict variations in the decline of relationship continuity at practice level, after accounting for the effects of organisational and population confounding variables, which themselves did not predict, or weakly predicted with very small effect sizes, the decline of continuity. Cross-sectionally, continuity and deprivation were negatively correlated within each year. CONCLUSION: The decline in relationship continuity of care has been marked and widespread. Measures to maximise continuity will need to be feasible for individual practices with diverse population and organisational characteristics.

History

Citation

British Journal of General Practice, 2018, bjgp18X696209

Author affiliation

/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Health Sciences

Version

AM (Accepted Manuscript)

Published in

British Journal of General Practice

Publisher

Royal College of General Practitioners

issn

0960-1643

eissn

1478-5242

Acceptance date

12/01/2018

Copyright date

2018

Available date

08/05/2019

Publisher version

http://bjgp.org/content/early/2018/05/07/bjgp18X696209

Notes

The file associated with this record is under embargo until 12 months after publication, in accordance with the publisher's self-archiving policy. The full text may be available through the publisher links provided above.

Language

en