Continuity of Care Increases Clinical Productivity in Primary Care

Abstract

Continuity of care, defined as an ongoing therapeutic relationship between a patient and a physician, is a defining characteristic of primary care services. However, arranging a consultation with one's regular doctor is increasingly difficult as practices seek to improve daily throughput to match rising consultation demand with an increasingly scarce clinical labor supply. The emergence of online providers accelerates this trend. We study the productivity implications of this reduction in care continuity by analyzing consultation-level data of over 10 million office consultations in 381 English primary care practices over a period of 11 years. We find that continuity of care has a significant productivity benefit. On average, the time to a patient's next visit is 13.2% (95% CI=[12.2%, 14.1%]) longer when the patient sees the doctor they have seen most frequently over the past two years, while there is no operationally meaningful difference in consultation length. The results are consistent across several model specifications that account for confounding and selection bias. The data also shows that the productivity benefit of care continuity is significantly larger for older patients, patients with multiple chronic conditions, and patients with mental health conditions. We estimate that the total demand for consultations in our sample would have fallen by 5.2% had all practices offered continuity of care at the level of the top decile of practices, prioritizing patient consultations that would yield the largest productivity benefits. We discuss operational and strategic implications of these findings for primary care practices and for third-party payers of their services.