Strategies to enhance teaching about continuity of care

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.

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.