Family Practice Advance Access originally published online on February 5, 2007
Family Practice 2007 24(2):128-137; doi:10.1093/fampra/cmm003
UK GPs' and practice nurses' views of continuity of care for patients with type 2 diabetes
a Centre for Research in Primary Care
b Academic Unit of Primary Care, University of Leeds, UK
c Department of General Practice, North Wales Clinical School, Cardiff University, UK
Correspondence to Dr Mohammed H Alazri, Family and Community Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, PO Box 35, Postal Code 123, Al-khood, Muscat, Sultanate of Oman, Oman; Email: mhalazri{at}squ.edu.om
Received 6 June 2006; Accepted 28 December 2006.
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Abstract |
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Background. Continuity of care is widely regarded as a core value of primary care. Type 2 diabetes is a common chronic disease with major health, social and economic impacts. Primary health care professionals in many countries are involved in the management of patients with type 2 diabetes, but their perspectives on continuity remain neglected in research.
Objective. To explore UK GPs' and nurses' experiences of continuity of care for patients with type 2 diabetes in primary care settings.
Methods. Semi-structured individual interviews were conducted with 16 GPs and 18 practice nurses who manage patients with type 2 diabetes recruited from 20 practices with various organizational structures in Leeds, UK.
Results. Three types of continuities were identified: relational continuity from the same health care professional, team continuity from a group of health care professionals and cross-boundary continuity across primary–secondary care settings. Relational continuity was influenced by the quality of the patient–health care professional relationship, policy of the National Health Service (NHS) in the UK (new General Medical Services contract), walk-in centres, the behaviour of receptionists and the structure and systems of the practice. Team and cross-boundary continuities were influenced by the relationship between team members and by effective communication. Relational continuity contributed to more ‘personal care’, but the usual health care professional might know less about diabetes. Team continuity was important in providing ‘physical care’, but patients could be confused by conflicting advice from different professionals. Cross-boundary continuity helps to provide ‘expert advice’, but is dependent upon effective communication.
Conclusion. GPs and practice nurses dealing with patients with type 2 diabetes identified three types of continuities, each influenced by several factors. Relational continuity deals better with psychosocial care while team continuity promotes better physical care; therefore, imposing one type of continuity may inhibit good diabetic care. Cross-boundary continuity between primary and secondary care is fundamental to contemporary diabetic services and ways should be found to achieve more effective communication.
Keywords. Continuity of care, general practice, GPs, practice nurses, type 2 diabetes.
Alazri MH, Heywood P, Neal RD and Leese B. UK GPs' and practice nurses' views of continuity of care for patients with type 2 diabetes. Family Practice 2007; 24: 128–137.