Reference: Br J Gen Pract. 2025 Jul 31;75(757):e518-e525
Practice Point: Advocating for improved continuity of care in your clinic may save more lives than meeting your HbA1c targets.
EBM Pearl: When meta-analysis isn’t possible due to disparate study methods, populations, or outcome measures, a qualitative systematic review can still offer good insight by identifying, appraising, and synthesizing available evidence in a systematic way.
A relationship is defined as the state of being connected. The doctor–patient relationship represents a special kind of connectedness—one that, according to a recent systematic review of over 15 million patients, could literally be a matter of life or death.
That won’t surprise anyone who has ever been one half of such a relationship. Nor will it shock those who experience how hard it is for patients to see the same primary care provider for many or most visits over time. The number of patients needing visits keeps rising while the number of clinicians able (and willing) to provide primary care keeps shrinking, at least here in the United States.
Previous systematic reviews that have linked continuity with improved patient outcomes were not specific to primary care. A Scandinavian research team recently conducted a large-scale systematic review that followed a predefined, transparent process to identify, appraise, and synthesize all available evidence specific to continuity in primary care. From more than 13,000 studies identified, the team ultimately included just 18 that met rigorous criteria, representing more than 15 million older adult patients.
The included studies measured continuity with the same primary care provider for up to 15 years and reported on mortality, hospital admissions, and emergency department visits. Variability in the continuity indices that were used as well as differences in thresholds for higher vs. lower continuity precluded meta-analysis. Instead, they performed a qualitative synthesis and graded the certainty of evidence for each outcome.
Across the body of evidence, higher continuity of primary care was linked to a 10%–15% reduction in all-cause mortality, a 10%–15% drop in hospital admissions, and a 15%–20% decrease in emergency department visits, all with moderate certainty. For context, the benefits of GLP-1s, reducing blood pressure by 10 mm Hg, and keeping HbA1c under 7.5% are all also in the 10%–15% range for reducing all-cause mortality. So—hear me out on this—imagine a world where we have continuity of care AND we meet all the quality metrics mentioned above. Our patients might live forever!
Obtaining and maintaining continuity in primary care is seriously one of the biggest challenges in health care in the United States right now. Primary care providers bear a lot of the brunt of the quality movement in a health care system that is designed to reward episodic and procedural care. Yet for all the energy poured into meeting quality metrics, perhaps we should direct just as much effort toward building systems that honor the intangible, deeply human benefits of long-term doctor–patient relationships. And the upside isn’t only for patients: Continuity is also tied to higher provider satisfaction and less burnout. So maybe we shouldn’t just imagine that world. We should insist on it.
For more information, see the topic Geriatric Health Maintenance in DynaMed.
DynaMed EBM Focus Editorial Team
This EBM Focus was written by Katharine DeGeorge, MD, MS, Senior Deputy Editor at DynaMed and Associate Professor of Family Medicine at the University of Virginia. Edited by Alan Ehrlich, MD, FAAFP, Executive Editor at DynaMed and Associate Professor in Family Medicine at the University of Massachusetts Medical School; Dan Randall, MD, MPH, FACP, Senior Deputy Editor at DynaMed; Claire Symanski, PhD, Medical Editor and Team Lead for ENT at DynaMed; McKenzie Ferguson, PharmD, BCPS, Senior Clinical Writer at DynaMed; Rich Lamkin, MPH, MPAS, PA-C, Clinical Writer at DynaMed; Matthew Lavoie, BA, Senior Medical Copyeditor at DynaMed; Hannah Ekeh, MA, Senior Associate Editor II at DynaMed; and Jennifer Wallace, BA, Senior Associate Editor at DynaMed.