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Background: Though critical to primary care, continuity of care has rarely been examined in China. This study aims to assess the relationship between continuity of care and healthcare costs among patients with chronic diseases within primary care settings in China.Methods: In this cross-sectional study, we used a social health insurance claims dataset of 1406 patients with hypertension and/or diabetes in Yuhuan City, Zhejiang Province collected in 2017-2019. We measured continuity of care using the Bice-Boxerman Continuity of Care (COC) Index, Herfindahl Index (HI), Sequential Continuity of Care (SECON) Index, Usual Provider of Care (UPC), and a binary variable indicating whether a patient's UPC was a primary care provider. We examined the associations between continuity of care and healthcare costs in the same period and the subsequent year, using ordinary least squares regression for the outpatient costs and two-part regression for the inpatient costs. Based on the regression coefficients, we predicted costs saved if each continuity measure was set to 1 from the status quo.Results: When optimum continuity were to be achieved, 7.12-27.29% of total outpatient costs and 55.38-73.35% of total inpatient costs could be saved compared to the status quo during the two-year study period. If optimum continuity were to be achieved in the first year, 7.47%-21.78% of total outpatient costs and 8.84-40.22% of total inpatient costs could be saved in the second-year.Conclusions: Care continuity indicators were consistently associated with reduced outpatient costs and hospitalization risks. Future health reform in China should further enhance continuity of care in primary care.

A proposed scoping study which will map out and identify, categorise, summarise and synthesize knowledge about continuity of care in health services research. The scoping study will adhere to PRISMA-P/ScR guidelines and to the development phase of Medical Research Council (MRC) framework for complex interventions. The objective is to explore how the concept of continuity of care is described within the context and population of community-dwelling older people and to identify nursing research within the broader field of health services research in primary healthcare.

A proposed scoping review which will map out and identify, categorise, summarise and synthesize knowledge about fundamental care needs in health services research. The scoping study will adhere to PRISMA-P/ScR guidelines and to the development phase of Medical Research Council (MRC) framework for complex interventions. The objective is to explore how the concept of fundamental care needs, integration of care and continuity of care is described within the context and population of community-dwelling older people, their relatives and care providers (such as nurses).

A proposed scoping review which will map out and identify, categorise, summarise and synthesize knowledge about fundamental nursing care needs among older people in long term care contexts. The scoping study will adhere to PRISMA-P/ScR guidelines and to the development phase of Medical Research Council (MRC) framework for complex interventions. The objective of this scoping review is to explore how the concept of fundamental nursing and continuity of care is described and targting older people in home- and facility-based care. As such, this scoping review will aid to provide a comprehensive overview of the scientific literature in relation to older peoples fundamental nursing needs, continuity of care and nursing interventions in long-term care.

Background Continuity of care, in particular personal continuity, is a core principle of general practice and is associated with many benefits such as a better patient-provider relationship and lower mortality. However, personal continuity is under pressure due to changes in society and healthcare. This affects older patients more than younger patients. As the number of older patients will double the coming decades, an intervention to optimise personal continuity for this group is highly warranted. Methods Following the UK Medical Research Council framework for complex Interventions, we will develop and evaluate an intervention to optimise personal continuity for older patients in general practice. In phase 0, we will perform a literature study to provide the theoretical basis for the intervention. In phase I we will define the components of the intervention by performing surveys and focus groups among patients, general practitioners, practice assistants and practice nurses, concluded by a Delphi study among members of our group. In phase II, we will test and finalise the intervention with input from a pilot study in two general practices. In phase III, we will perform a stepped wedge cluster randomised pragmatic trial. The primary outcome measure is continuity of care from the patients’ perspective, measured by the Nijmegen Continuity Questionnaire. Secondary outcome measures are level of implementation, barriers and facilitators for implementation, acceptability and feasibility of the intervention. In phase IV, we will establish the conditions for large-scale implementation. Discussion This is the first study to investigate an intervention for improving personal continuity for older patients in general practice. If proven effective, our intervention will enable General practitioners to improve the quality of care for their increasing population of older patients. The pragmatic design of the study will enable evaluation in real-life conditions, facilitating future implementation. Trial registration number Netherlands Trial Register, trial NL8132. Registered 2 November 2019.

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.

Humanism in medicine is defined as health care providers' attitudes and actions that demonstrate respect for patients' values and concerns in relation to their social, psychological and spiritual life domains. Specifically, humanistic clinical medicine involves showing respect for the patient, building a personal connection, and eliciting and addressing a patient's emotional response to illness. Health information technology (IT) often interferes with humanistic clinical practice, potentially disabling these core aspects of the therapeutic patient-physician relationship. Health IT has evolved rapidly in recent years - and the imperative to maintain humanism in practice has never been greater. In this vision paper, we aim to discuss why preserving humanism is imperative in the design and implementation of health IT systems.

Objective The aim was to explore the experiences of a patient-reported outcome (PRO)-based tele-health follow-up from the perspective of patients with rheumatoid arthritis (RA) and their experiences of increasing their active role and responsibility for disease control in particular. Methods Adopting a strategy of interpretive description, we conducted individual, semi-structured interviews with 15 RA patients participating in a tele-health follow-up. Participants were selected purposively and consecutive from both genders and with various ages, disease durations and disease severity. The analysis was inductive with a constant comparative approach. First, we identified the main themes conveying the participants’ experiences. Then, we constructed patient typologies to explain different perspectives on the tele-health follow-up. Results Five themes covered the participants’ experiences: ‘A flexible solution’, ‘Responsibility’, ‘Knowledge of RA’, ‘Communication and involvement’ and ‘Continuity’. Two typologies: ‘the keen patient’ and ‘the reluctant patient’ represented opposite perspectives and preferences regarding the core value of and approach to the tele-health follow-up. Conclusion The participants had positive perceptions of the PRO-based tele-health follow-up and saw it as a flexible and resource-saving solution. They reported disadvantages related to missing face-to-face contact with health professionals (HPs). The two typologies, ‘the keen’ and ‘the reluctant’ patient, help us understand the patients’ different needs, wishes and abilities to take part in tele-health follow-up. Our findings reveal a need for more insight into how tele-health follow-up could be integrated in routine clinical practice, paying special attention to how reluctant patients may be supported. This article is protected by copyright. All rights reserved.

Humanism in medicine is defined as health care providers' attitudes and actions that demonstrate respect for patients' values and concerns in relation to their social, psychological and spiritual life domains. Specifically, humanistic clinical medicine involves showing respect for the patient, building a personal connection, and eliciting and addressing a patient's emotional response to illness. Health information technology (IT) often interferes with humanistic clinical practice, potentially disabling these core aspects of the therapeutic patient-physician relationship. Health IT has evolved rapidly in recent years - and the imperative to maintain humanism in practice has never been greater. In this vision paper, we aim to discuss why preserving humanism is imperative in the design and implementation of health IT systems.

Humanism in medicine is defined as health care providers' attitudes and actions that demonstrate respect for patients' values and concerns in relation to their social, psychological and spiritual life domains. Specifically, humanistic clinical medicine involves showing respect for the patient, building a personal connection, and eliciting and addressing a patient's emotional response to illness. Health information technology (IT) often interferes with humanistic clinical practice, potentially disabling these core aspects of the therapeutic patient-physician relationship. Health IT has evolved rapidly in recent years - and the imperative to maintain humanism in practice has never been greater. In this vision paper, we aim to discuss why preserving humanism is imperative in the design and implementation of health IT systems.

BackgroundMidwives are primary providers of care for childbearing women around the world. However, there is a lack of synthesised informationto establish whether there are differences in morbidity and mortality, effectiveness and psychosocial outcomes between midwife-ledcontinuity models and other models of care.ObjectivesTo compare midwife-led continuity models of care with other models of care for childbearing women and their infants.Search methodsWe searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (28 January 2013) and reference lists of retrieved studies.Selection criteriaAll published and unpublished trials in which pregnant women are randomly allocated to midwife-led continuity models of care or other models of care during pregnancy and birth.Data collection and analysisAll review authors evaluated methodological quality. Two review authors checked data extraction.Main resultsWe included 13 trials involving 16,242 women. Women who had midwife-led continuity models of care were less likely to experience regional analgesia (average risk ratio (RR) 0.83, 95% confidence interval (CI) 0.76 to 0.90), episiotomy (average RR 0.84, 95% CI 0.76 to 0.92), and instrumental birth (average RR 0.88, 95% CI 0.81 to 0.96), and were more likely to experience no intrapartum analgesia/anaesthesia (average RR 1.16, 95% CI 1.04 to 1.31), spontaneous vaginal birth (average RR 1.05, 95% CI 1.03 to 1.08),attendance at birth by a known midwife (average RR 7.83, 95% CI 4.15 to 14.80), and a longer mean length of labour (hours) (mean difference (hours) 0.50, 95% CI 0.27 to 0.74). There were no differences between groups for caesarean births (average RR 0.93, 95% CI 0.84 to 1.02).Women who were randomised to receive midwife-led continuity models of care were less likely to experience preterm birth (average RR 0.77, 95% CI 0.62 to 0.94) and fetal loss before 24 weeks’ gestation (average RR 0.81, 95% CI 0.66 to 0.99), although there were no differences in fetal loss/neonatal death of at least 24 weeks (average RR 1.00, 95% CI 0.67 to 1.51) or in overall fetal/neonatal death (average RR 0.84, 95% CI 0.71 to 1.00).Due to a lack of consistency in measuring women’s satisfaction and assessing the cost of various maternity models, these outcomes were reported narratively. The majority of included studies reported a higher rate of maternal satisfaction in the midwifery-led continuity care model. Similarly there was a trend towards a cost-saving effect for midwife-led continuity care compared to other care models.Authors’ conclusionsMost women should be offered midwife-led continuity models of care and women should be encouraged to ask for this option although caution should be exercised in applying this advice to women with substantial medical or obstetric complications.

This perspective paper makes a brief conceptual review of continuity and argues that relationship continuity is the most controversial type. Plentiful evidence of association with better satisfaction and outcomes urgently needs to be supplemented by studies of causation. The scope of these has been outlined in this paper. Evidence strongly suggests that patients generally want more relationship continuity than they are getting and that relationship continuity is linked with better patient and staff satisfaction. This is reason enough to justify improving relationship continuity for patients.