Continuity of care and referral rate: challenges for the future of health care

Abstract

Background: Continuity of care could reduce health care consumption by patients and reduce the number of referrals to specialist care, but it is unknown if there is a difference in referral rates to specific medical specialties.

Aim: We aimed to determine the relationship between continuity of care and both the referral rate (referrals per patient per year) and the medical specialties for which this relationship was strongest.

Design and setting: A retrospective cohort study of 19333 patients in primary care in the north of the Netherlands.

Method: Patients with at least two contacts with a general practitioner (GP) over a 2-year period (2013-2014) were included. The number of contacts with their own or other GPs were calculated, and referral rates were determined. Continuity of care was included as a dichotomous variable (absent or present).

Results: The odds of being referred were higher for older patients, females and patients with more practitioner contacts. However, the presence of continuity of care was associated with the highest odds of referral. The referral rate was significantly highest for patients with continuity of care when referred to paediatrics, as well as for patients without continuity of care who were referred to gastroenterology, ophthalmology and psychiatry.

Conclusion: Increased continuity of care decreases referral to specialist care, most notably for referrals to paediatrics. Despite continued pressures on continuity of care, policy makers should invest in this cornerstone of primary care to temper health care expenditures.

Keywords: Continuity of care; consultation; doctor–patient relationship; practice management; primary care.