A comprehensive analysis of patients' perceptions of continuity of care and their associated factors

Int J Qual Health Care. 2013 Jul;25(3):291-9. doi: 10.1093/intqhc/mzt010. Epub 2013 Feb 19.


Objective: To determine the patients' perceived degree of continuity of care between primary and secondary care and to identify contextual and individual factors that influence patients' perceptions of continuity of care.

Design: Cross-sectional study by means of a survey of patients attended to in primary and secondary care.

Setting: Three health-care areas of the Catalonian public health-care system.

Participants: A random sample of 1500 patients.

Main outcome measures: Relational, informational and managerial continuity of care measured by means of Likert scales, using the CCAENA questionnaire.

Results: Overall, 93.8 and 83.8% of patients perceived an ongoing relationship with primary and secondary care physicians, respectively (relational continuity), 71.2% perceived high levels of information transfer (informational continuity) and 90.7% perceived high levels of consistency of care (managerial continuity). Patients from health-care areas where primary and secondary care were managed by a single organization and the elderly tended to perceive higher levels of all three types of continuity. Foreign-born patients were less likely to perceive relational continuity with primary care physicians; those with higher educational levels were less likely to perceive high levels of informational continuity and patients with worse health status were less likely to report high levels of managerial and relational continuity with secondary care physicians.

Conclusions: Study results suggest high levels of perceived continuity of care, especially for relational and managerial continuity. The adopted comprehensive approach proves to be useful to properly understand the phenomenon because perceptions and associated factors vary according to the type of continuity.

Keywords: continuity of patient care; health-care levels; health-care surveys; physician–patient relations.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Attitude to Health*
  • Continuity of Patient Care / standards*
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Physician-Patient Relations
  • Spain
  • Young Adult