Relational and management continuity survey in patients with multiple long-term conditions

Objective: To quantify problems of relational and management continuity of care in patients with multiple long-term conditions. Methods: A mailed questionnaire survey was conducted among people aged 60 years and older from 15 general practices. The questionnaire included 16 items concerning relational and management continuity of care. The number of long-term conditions was measured using the Self-Administered Comorbidity Questionnaire. Results: Data were analysed for 1,125 participants, a response rate of 37%. There were 123 (11%) with no long-term conditions, 225 (20%) with one, 284 (25%) with two, 218 (19%) with three and 275 (24%) with four or more. Factor analysis confirmed two factors with seven items for management continuity (alpha 0.88) and nine items for relational continuity (alpha 0.83). Experiences of difficulties with management continuity were higher in participants with three long-term conditions or more (adjusted odds ratio 2.01, 95% confidence interval 1.09 to 3.73), with 'poor' self-rated health (2.21, 1.21 to 4.02), or at least three hospital outpatient attendances each year (2.60, 1.32 to 5.12). The number of long-term conditions was not consistently associated with relational continuity. Difficulties of relational continuity were experienced by participants with 'poor' self-rated health (2.11, 1.16 to 3.85). Patients with more frequent general practice consultations experienced fewer difficulties of relational continuity (0.63, 0.42 to 0.92). Conclusion: People with many long-term conditions are at increased risk of inadequate management continuity with potential negative impacts on their care. Experiences of relational continuity, with potential buffering effects, are not associated with the number of long-term conditions. Journal of Health Services Research & Policy Vol 16 No 2, 2011: 67-74 (C) The Royal Society of Medicine Press Ltd 2011