Thursday, March 28, 2024

Denis Pereira Gray | Continuity of Care

by Editor

Professor Sir Denis Pereira Gray is one of the world leaders in Primary Care Research

Watch the video and enjoy the conversation

In conversation with... Professor Sir Denis Pereira Gray

A lifelong research interest in Continuity of Care

Continuity of care was a long-standing feature, particularly of general practice, for years but it sort of got slightly out of fashion because people didn’t think it was terribly important, and life got very busy and all the rest of it, and what’s really interesting now is that the latest research is suggesting, actually, that it’s very important indeed  Indeed, so important that it actually reduces mortality.

Well it goes right back, and my interest is back to the 1970s, and it grew out of my work as a family doctor because it grew on me that it was more and more important if patients were comfortable with the doctor. And then I realised the more I knew about patients I thought the better it worked so, I did do a little bit of research on it and showed that, in fact, a doctor who knew the patients was able to give advice on health education more than if they didn’t know who the patient really was. And then over the years we’ve done a number of studies. 

I was lucky to link up with some Americans  and, particularly a chap called Arch Mainous who  was interested in trust. And we did a big study to see if trust was related to continuity and we found that was a very strong association that, broadly speaking, the longer patients had had a family doctor, the more they they grew to trust the advice that they got. And then, in another American collaboration with a different set in New York and with Moira Stewart in in Canada, we did a three-nation study to look at the way patients respond to GP’s.

Responsiveness is a psychological measure of how flexible and adaptable the family doctor is.  And, what was interesting is that we found that long continuity led to the patient thinking that the doctor was more responsive. So we had an absolutely fascinating pair that we now discover that patients change over time, patients become more trusting, they’re not the same all the time and, lo and behold, GPs change.  The longer they have it, the GP gets more sensitive to the patient’s particular needs.

That seems sort of quite exciting and that then led on to us asking a big question, could all this possibly affect death rates. That’s the ultimate outcome in medicine so,  a team I’m part of in Exeter,  did the first systematic review of the relationship between continuity, as measured with the doctors, and mortality, death rates, and we were very interested that, in fact, in 18 out of 22 studies, we found there was a statistically significant association with lower mortality when if the patient had had doctor continuity.”

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