Abstract
PurposeProviding good continuity of care to patients is considered a vital component of community mental health services, but there is limited evidence that it is associated with good outcomes. We measured service use and a multidimensional concept of continuity of care in 323 patients who were to be discharged from hospital following compulsory treatment for psychosis to investigate the association between continuity and rehospitalisation.MethodsWe conducted a 36-month prospective cohort study of the patients recruited to the Oxford Community Treatment Order Trial (OCTET). We collected data from medical records on eight previously operationalized measures of continuity. We conducted regression analyses to determine the association between these measures and readmission to hospital, time to readmission, and the number of days spent in hospital.ResultsAlmost two thirds (n = 206, 63.8%) of patients were readmitted. Patients were seen frequently, with a mean of 2.9 (SD = 2.47) contacts a month throughout the follow-up. Less frequent contact was significantly associated with lower odds of rehospitalisation and fewer days in hospital. More changes in the patient’s care coordinator were associated with more time in hospital. Patients who had a higher proportion of clinical correspondence copied to them spent fewer days in hospital.ConclusionPatients with severe and relapsing psychotic illness are seen frequently and consistently in community mental health services. Higher levels of patient contact could be a response to the severity of illness rather than a marker of quality of care. Using a simple linear interpretation of contact frequency as a measure of continuity of care in this patient group may be of limited value in modern services.
Highlights
Continuity of care can broadly be defined as a process of delivering care to an individual patient over time which is perceived by both the patient and care providers as comprehensive, consistent, and connected
Three randomised patients were excluded in the original OCTET trial as they were ineligible [9]
The majority of patients had a diagnosis of schizophrenia (n = 275, 85.1%)
Summary
Continuity of care can broadly be defined as a process of delivering care to an individual patient over time which is perceived by both the patient and care providers as comprehensive, consistent, and connected. It is considered a cornerstone of modern health care provision and is included as an indicator of quality of care in national and international health policy [1, 2]. Despite the importance placed on providing continuity, its definitions differ. The eight-dimensional definition of Freeman et al comprising experienced, flexible, crossboundary, information, longitudinal, relational, long-term, and contextual continuity is an influential example [5]
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