Carolyn Tarrant1, Kate Windridge2, Richard Baker2, George Freeman3, Mary Boulton4. 1. Department of Health Sciences, University of Leicester, Leicester, ccp3@le.ac.uk. 2. Department of Health Sciences, University of Leicester, Leicester. 3. Department of Primary Care and Public Health, Imperial College London, London and. 4. Department of Clinical Health Care, Oxford Brookes University, Oxford, UK.
Abstract
BACKGROUND: Experienced continuity is important for good quality primary care but may be challenging to achieve. Little is known about how discontinuities or gaps in care may arise, how they impact on patients' experiences and how best to understand them so that they can be avoided or managed. OBJECTIVES: Using the theoretical framework of candidacy, we aim to explore patients' experiences of discontinuities in care and to gain insight into how gaps come to be bridged and why they might remain unresolved. METHODS: A secondary analysis was undertaken of interview data from a large study into continuity in primary care, involving a diverse sample of 50 patients, recruited from 15 general practices, one walk-in centre and community settings in Leicestershire, UK. Analysis was conducted using a constant comparative approach. RESULTS: Experiences of gaps in care were common, arising from failures in communication and coordination of care. Although some gaps were easily bridged, many patients described 'falling through gaps' because of difficulties establishing their candidacy for ongoing care when gaps occurred. These patients commonly had complex, chronic conditions and multi-morbidity. Bridging gaps required resources; relationship continuity was a valuable resource for preventing and repairing gaps in care. When gaps were not bridged, distress and dysfunctional use of health services followed. CONCLUSION: This study demonstrates that some patients with complex chronic conditions and multi-morbidity may be unable to get the continuity they need and highlights the potential for relationship continuity to help prevent vulnerable patients falling through gaps in care.
BACKGROUND: Experienced continuity is important for good quality primary care but may be challenging to achieve. Little is known about how discontinuities or gaps in care may arise, how they impact on patients' experiences and how best to understand them so that they can be avoided or managed. OBJECTIVES: Using the theoretical framework of candidacy, we aim to explore patients' experiences of discontinuities in care and to gain insight into how gaps come to be bridged and why they might remain unresolved. METHODS: A secondary analysis was undertaken of interview data from a large study into continuity in primary care, involving a diverse sample of 50 patients, recruited from 15 general practices, one walk-in centre and community settings in Leicestershire, UK. Analysis was conducted using a constant comparative approach. RESULTS: Experiences of gaps in care were common, arising from failures in communication and coordination of care. Although some gaps were easily bridged, many patients described 'falling through gaps' because of difficulties establishing their candidacy for ongoing care when gaps occurred. These patients commonly had complex, chronic conditions and multi-morbidity. Bridging gaps required resources; relationship continuity was a valuable resource for preventing and repairing gaps in care. When gaps were not bridged, distress and dysfunctional use of health services followed. CONCLUSION: This study demonstrates that some patients with complex chronic conditions and multi-morbidity may be unable to get the continuity they need and highlights the potential for relationship continuity to help prevent vulnerable patients falling through gaps in care.
Authors: Sina Waibel; Diana Henao; Marta-Beatriz Aller; Ingrid Vargas; María-Luisa Vázquez Journal: Int J Qual Health Care Date: 2011-12-06 Impact factor: 2.038
Authors: Stephen M Campbell; Evangelos Kontopantelis; David Reeves; Jose M Valderas; Ella Gaehl; Nicola Small; Martin O Roland Journal: Ann Fam Med Date: 2010 Nov-Dec Impact factor: 5.166
Authors: Patrick Tobin-Schnittger; Jane O'Doherty; Ray O'Connor; Andrew O'Regan Journal: Prim Health Care Res Dev Date: 2017-12-07 Impact factor: 1.458
Authors: Richard Baker; George K Freeman; Jeannie L Haggerty; M John Bankart; Keith H Nockels Journal: Br J Gen Pract Date: 2020-08-27 Impact factor: 5.386
Authors: Sina Waibel; Ingrid Vargas; Marta-Beatriz Aller; Jordi Coderch; Joan Farré; M Luisa Vázquez Journal: BMC Health Serv Res Date: 2016-09-02 Impact factor: 2.655