Sequential continuity of care by general practitioners: which patients change doctor?

To identify individual and social characteristics of patients making sequential visits to a different rather than the same general practitioner (GP).

Data for this study were extracted from the "Record Linkage Pilot Study" of the National Centre for Epidemiology and Population Health, which linked information from personal interviews with Health Insurance Commission and National Heart Foundation Risk Factor Survey data. Each sequence of visits (any two consecutive visits) made by each participant to the same or a different GP from January 1991 to December 1992 was treated as an event.

521 subjects aged between 23 and 72 years who gave consent to release of Health Insurance Commission data.

A visit to the same GP or a different GP from the one seen at the last visit.

Logistic regression analysis showed that younger age, good physical functioning, good self-rated health, normal body mass index, shiftwork and a longer time interval between visits were significantly associated with less continuity of care.

Our study raises questions about the relationship between chronological continuity and quality of care. For example, if infrequent visits (associated with less continuity) are for distinct illnesses, is quality of care affected by information or treatment from a previous visit? Our results also suggest that some GPs, because of the demography of their practices (more young people, a higher proportion of shift workers), may be disadvantaged by continuity-based reward systems. Moreover, because of lack of continuity young people may miss out on GPs' health promotional activities.