Three dimensions of Continuity of Care
It is widely recognized that "continuity of care" is very important. The term generally means cooperative management of a patient's health by their medical team, thereby improving the patient's quality of health care over time. But did you know that the evidence defines continuity in three dimensions? There are three interdependent types of continuity.
- Relational: The ongoing, trusting, therapeutic relationship between a single primary health care provider (or which can include a small team of health care providers) and a patient. It's based on the patient seeing the same provider and team consistently.
- Informational: Communication of facts and opinions across team, institutional, and professional boundaries, and between providers and patients. It's often enabled by clear communication processes and technology.
- Management: The coordination and hand-off of care between relevant care providers using a shared care plan in a way that is both consistent and flexible to meet patient needs. It involves the integration of primary and acute care.
The Patient's Medical Home, a family practice where the patient feels most comfortable to discuss their personal and family health concerns, is attainable through continuity. Primary Care Networks throughout Alberta are supporting their clinics in buildings Patient's Medical Homes and helping patients get better continuity of care.
Primary Care Networks implement the Patient's Medical Home.
It is described as "a family practice defined by its patients as the place they feel most comfortable - most at home - to present and discuss their personal and family health and medical concerns..." PCNs support their member clinics in becoming PMHs by:
Helping member clinics rethink processes and delivery models.
Providing services and programs that aren't economical in a single clinic.
Coordinating referrals to specialty care.
Connecting patients to community programs.
A review of 115 articles shows that implementing PMH is associated with: cost savings, reduced health care utilization by patients, fewer emergency visits & hospitalization in patients with chronic diseases, improved preventative service delivery rates, improved quality, and increased patient and provider satisfaction.
After-hours clinics reduce ER visits.
Primary Care Networks are integral to providing enhanced access to care for Albertans through after-hours clinics. Many PCNs, including those in rural communities, provide after-hours clinics to patients.
Improved access to a family doctor reduces emergency rooms visits.
The Case for Continuity.
Continuity is essential and foundational change elements in the implementation of the Patient’s Medical Home.
Evidence is clear that when patients have a longitudinal relationship with a single family physician, results are better quality of care and a reduced overall health care system utilization and costs. This means that patients who regularly visit a family doctor are healthier and live longer.
PCNs reduce acute care use.
Primary Care Networks (PCNs) improve access to primary health care services and reduce acute care costs. Health Quality Council of Alberta research confirms that patients attached to a Primary Care Network (PCN) showed decreased use of acute care services (e.g., Emergency room visits, reduced length of hospital stay) while visits to their family doctor increased. When patients visit their family doctor consistently it results in better continuity of care for them and ultimately saves the health care system money.
Investing in primary care bends the cost curve and improves patient care.
No jurisdiction has reduced health care costs without a significant investment in primary care. 1.2% of the overall government health care budget is spent on Primary Care Networks. Research confirms that increasing investments in primary care curbs health care spending in other areas such as acute care (e.g., emergency departments) and improves health outcomes. Increased investment in primary care is consistently associated with lower rates of hospitalization for conditions that should be preventable by accessing primary care services. Alberta data from various sources including Alberta Health Services and Health Quality Council of Alberta has shown the cost curve in Alberta has been positively impacted by government's investment in PCNs and primary care.
Primary Care Networks make it easy to find family doctors accepting new patients.
Over 900 Primary Care Networks family doctors are accepting new patients. Albertans looking for a family physician can visit
www.pcnpmo.ca/findadoctor to find one near them. PCNs created this service because access to the same family doctor builds a relationship for a healthy future. Research confirms that patients who regularly visit a family doctor are healthier and live longer.
Alberta spends more on average than the other provinces for health care delivery.
Evidence shows increased spending in primary care yields system level savings, less hospital utilization and better health outcomes for patients. Health care costs are driven by the common chronic diseases (e.g., diabetes, hypertension, depression) that are best managed in primary care every day. One of the most effective ways of reducing health care costs and utilization is to have and access a family doctor. Primary Care Networks improve access to family doctors.
Primary Care Networks are at the heart of health care in Alberta.
There are 42 Primary Care Networks (PCNs) in Alberta providing care to over 3.5 million Albertans. Over 3,700 family physicians and 1,000 allied health professionals work in PCNs. 80% of the overall PCN staff budget is spent on allied health professionals such as nurses, dietitians, pharmacists, social workers, and mental health professionals. The other 20% is spent on administrative roles that support PCNs’ operations. PCNs build health teams to help Albertans get the right care, at the right time, by the right team member.