Evaluation of provider continuity in primary care: actual versus random and potential continuity

Continuity of care is an important factor in the quality of primary care. Unfortunately there is no common view about its definition, measurement, determinants or relationship to outcome. Using a visit-based approach to the measurement of continuity, the present study examines the effects of organizational changes, including the introduction of a new appointment system, on physician continuity at a Swedish primary health care centre. This allows the concepts of random and potential continuity to be introduced, providing norms against which the achieved levels of actual continuity can be rated. The results show that the actual physician continuity, although not particularly high, was considerably higher than what could be expected according to chance alone (random continuity). Moreover, actual continuity did appear to increase after the organizational changes were implemented--absolutely as well as in relation to potential continuity. The importance of reducing the mobility of physicians is emphasized in order to further improve the situation.