Impact of continuity on quality of primary care: from the perspective of citizens' preferences and multimorbidity - position paper of the European Forum for Primary Care.

BACKGROUND: Continuity of care is one of the cornerstones of primary care. Initially, the concept of continuity largely corresponded to one care provider and continuity between doctor and patient, but today, healthcare processes and organisations have grown and become more complex. A survey of patients with complex care needs found that in all of 11 countries studied care was often poorly coordinated. Multidimensional models of continuity have to be developed. AIM: To study existing evidence concerning significance of continuity in primary care with special consideration given to the preferences of citizens and to patients with complex care needs. METHODS: Contemporary literature was studied from the aspects of primary care, patients' point of view, multimorbidity and organisational models. Examples from country systems were collected. The topic and drafts were presented and discussed at two EFPC conference workshops. RESULTS: Evidence shows that both patients and caregivers identify and value continuity in the form of regular sources of care, and that provider continuity is related to lower total healthcare costs on a macro level. Continuity is a considerable component of quality in primary care. Methods to measure and compare between primary care centres, organisations and countries to stimulate improvements in continuity is lacking. The complexity of operationalising continuity in the context of multidisciplinary team-based primary care today and in the future remains a challenge. CONCLUSIONS: Continuity is, and will be, an important component of quality in primary care, especially from the perspective of citizens and growing multimorbidity. Methods to develop continuity should be promoted.