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Can Fam Physician
Vol. 55, No. 6, June 2009, pp.666 - 668
Copyright © 2009 by The College of Family Physicians of Canada
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Seminar

Strategies to enhance teaching about continuity of care

Karen Schultz, MD CCFP FCFP
Assistant Professor in the Department of Family Medicine at Queen’s University in Kingston, Ont.

Correspondence: Dr Karen Schultz, Department of Family Medicine, Queen’s University, 220 Bagot St, Kingston, ON K7L 5E9; telephone 613 533-9303; e-mailkws{at}queensu.ca

Continuity of care is getting cookies. And not just any cookies, but homemade cookies!
Family medicine resident (K.S. and J. Kerr, unpublished data, 2009)

Continuity of care is a cornerstone of family medicine, improving physician and patient satisfaction and patient outcomes.1–4 Focus groups with residents and practising physicians highlight that long-term relationships with patients are among their key reasons for becoming family physicians (K.S. and J. Kerr, unpublished data, 2009). Given its importance, teaching about continuity of care during residency training should be thoughtfully deliberate.

Background

Hennen5 defined continuity of care as having 6 components: chronologic or longitudinal, informational, geographic, interdisciplinary, family, and interpersonal (Table 11,2,4–8). These components of continuity of care have been conceptualized as relating to each other in a hierarchy with "at least some informational continuity being required for longitudinal continuity to be present and that longitudinal continuity is required for interpersonal continuity to exist."6 Although all aspects of continuity of care are important, it is interpersonal continuity of care that is the strongest predictor of positive physician and patient outcomes.


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  		Table 1. Teaching strategies for each of the 6 components of the continuity of care

 
The positive aspects of interpersonal continuity of care tend to be easily articulated. However, if we dig a little deeper, it is also obvious that continuity of care can create many difficulties: complacency, a heightened sense of responsibility with increased worry, friction between work and personal life, boundary issues, patient dependency, grief, and dealing with difficult patients.9 Many of these factors are associated with physician stress and burnout. In teaching residents about the benefits of continuity of care, therefore, it is equally important to deliberately teach about the difficult aspects of long-term therapeutic relationships and discuss coping strategies to deal with them.

Evidence from literature and best practices

Table 11,2,4–8 suggests several ways to try and enhance teaching about the various components of continuity of care, ultimately working to enhance the development of interpersonal continuity of care. Different office setups will make some suggestions more or less workable. Thinking about the underlying intent of teaching about continuity of care (ie, facilitating the development of significant therapeutic relationships between residents and patients) will hopefully allow preceptors to modify some of the suggestions that are not immediately applicable in their settings. All suggestions presume that residents are developing cohorts of patients considered "theirs" during their rotations, and that residents must follow up on investigations and management choices for these patients.


TEACHING TIPS

  • Teach residents not only the benefits of continuity of care but also the difficult aspects of long-term therapeutic relationships.
  • Be a role model and discuss with residents the job satisfaction from continuity of care.
  • Provide opportunities for residents to get more involved in and be responsible for patient care.

 


CONSEILS AUX ENSEIGNANTS

  • Enseignez aux résidents non seulement les bienfaits de la continuité des soins mais aussi les aspects difficiles des relations thérapeutiques à long terme.
  • Agissez comme modèle à imiter et discutez avec les résidents de la satisfaction professionnelle que procure la continuité des soins.
  • Donnez la possibilité aux résidents de participer davantage et d’assumer plus de responsabilités dans les soins aux patients.

 

Footnotes

Competing interests

None declared


Seminar is a new quarterly series in Canadian Family Physician, coordinated by the Section of Teachers of the College of Family Physicians of Canada. The focus is on practical topics for all teachers in family medicine, with an emphasis on evidence and best practice. Please send any ideas, requests, or submissions to Dr Allyn Walsh, Seminar Coordinator at walsha{at}mcmaster.ca.

 

References

  1. Guthrie B, Wyke S. Personal continuity and access in UK general practice: a qualitative study of general practitioners’ and patients’ perceptions of when and how they matter. BMC Fam Pract 2006;7:11.[Medline]
  2. Ridd M, Shaw A, Salisbury C. "Two sides of the coin"—the value of personal continuity to GPs: a qualitative interview study. Fam Pract 2006;23(4):461–8. Epub 2006 Apr 4.[Abstract/Free Full Text]
  3. Saultz J, Albedaiwi W. Interpersonal continuity of care and patient satisfaction: a critical review. Ann Fam Med 2004;2(5):445–51.[Abstract/Free Full Text]
  4. Gray DP, Evans P, Sweeney K, Lings P, Seamark D, Dixon M, et al. Towards a theory of continuity of care. J R Soc Med 2003;96(4):160–6.[Free Full Text]
  5. Hennen B. Continuity of care. In: Shires DB, Hennen BK, Rice DI, editors. Family medicine: a guidebook for practioners of the art. 2nd ed ed. New York, NY: McGraw-Hill; 1987. p. 3–7.
  6. Saultz JW. Defining and measuring continuity of care. Ann Fam Med 2003;1(3):134–43.[Abstract/Free Full Text]
  7. Schers H, van den Hoogen H, Grol R, van den Bosch W. Continuity of care through medical records—an explorative study on GPs’ management considerations. Fam Pract 2006;23(3):349–52. Epub 2006 Mar 7.[Abstract/Free Full Text]
  8. Kearley KE, Freeman GK, Heath A. An exploration of the value of the personal doctor-patient relationship in general practice. Br J Gen Pract 2001;51(470):712–7.[Medline]
  9. Arnetz BB. Psychosocial challenges facing physicians of today. Soc Sci Med 2001;52(2):203–13.[Medline]



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