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Continuity of care and clinical outcome: a prospective cohort study
J Bindman1, S Johnson, G Szmukler
1Section of Community Psychiatry (PRiSM), Institute of Psychiatry, De Crespigny Park, London, UK.
Background:
Continuity of care is a central objective of community psychiatric services, but there is no consensus about its measurement.
Aims:
We developed measures of continuity of care suitable for routine use, and measured continuity and individual patient outcome over a period in which community services were developing.
Method:
One hundred patients with severe mental illness receiving continuing care from two sectorised services were sampled and interviewed. Data were collected concerning their care over 20 months prior to interview. After 20 months prospective follow-up, they were re-interviewed. Continuity was defined as: perceived accessibility of services and knowledge about them, the number of keyworkers in a defined period of time, and the proportion of time out of contact with services.
Results:
Continuity of care improved significantly on all measures over the period of the study. Individual patient outcome also improved, but in multiple regression models including clinical and demographic variables, measures of continuity were not significant predictors of outcome. Continuity was similar for white and non-white patients.
Conclusion:
Simple measures of continuity are useful in evaluating changes in the process of care, but they are not straightforwardly related to individual outcome.