From Episodic to Continuing Care

Abstract

“Continuing care” is the term applied to the care of patients with chronic problems and/or the management of acute illness which needs review on one or more occasions. Continuing care is, therefore, the antithesis of episodic acute medicine, and the need for continuing PHC increases as the number of people with chronic or disabling problems increases in the population. The term must not be confused with continuity of care which refers to the patient seeing the same doctor (or nurse or aide) in personal PHC or family medicine. Continuity of care does not guarantee good continuing care as many “personal PHC clinicians”have not adopted the skills, tools or discipline of continuing care. Unfortunately, the very nature of PHC tempts the clinician to allow his care to become episodic because so many patients come for help with one acute problem, and pressure of time can easily become a barrier or an excuse to avoid wider continuing care responsibilities in a high proportion of patients. Videotape recordings in British general practice have shown that only about one patient in seven has more than one problem handled at each consultation, and an analysis of medical records has shown how fewer than 50% of elderly patients have two or more problems considered when they attend for PHC, despite the chronic and recurring nature of their disabilities (Stott 1980).