Morbidity, continuity of care and general practitioner workload: Is there a connection?

Aim: To examine whether morbidity influences the likelihood of patients seeking care from a personal health care provider and to describe the associated workload implications for that provider. Methods: A random sample was taken from the practice population of a well-established, stable four-doctor suburban practice and divided into a personal provider continuity or discontinuity group, based on their modified continuity index (MCI) score. To be included in the sample, patients had to have attended four or more times between July 1995 and June 1997. The general practice-specific care category (GP-SCC) model was used to place each patient into one of four morbidity groups. Results: The random sample of the practice population comprised 245 patients (126 males, 119 females) out of a total of approximately 4000. The mean age of the practice population was 42.9 years (confidence interval (CI): 39.6–46.1; range: 0–95). A total of 53.5% (CI: 47.3–59.7) of the practice population had personal provider continuity and 46.5% (CI: 40.3–52.7) did not. The mean number of visits during the study period was 10.67 (CI: 9.62–11.77). Patients in the personal provider continuity group had twice as many visits (14.15 visits, CI: 12.38–15.92) than those in the discontinuity group (6.72 visits, CI: 6.1–7.24, p < 0.001). The mean number of health issues discussed during the study period was 13.19 (CI: 11.74–14.63). Patients in the personal provider continuity group had more than twice as many health problems discussed (15.57–20.31 problems) than those in the discontinuity group (7.06–8.40 problems, p < 0.001). This pattern of workload distribution between the continuity and discontinuity groups was seen in all four morbidity groups, independent of the patient’s age or total number of visits. Conclusions: This study suggests that morbidity, age and frequency of visits per se are poor indicators of a patient’s likelihood for seeking care from one provider. Independent of morbidity, patients who seek care from the same provider double a doctor’s workload. Further research is needed to explore which patient, doctor and consultation characteristics explain these findings.