Inter-practice variability in registrar experiences of continuity of care: a cross-sectional analysis from the Registrar Clinical Encounters in Training study.

Abstract

Background: Continuity of care is a defining feature of general practice, with strong evidence for improved patient outcomes. Variability in practices' rates of continuity could markedly influence general practitioner (GP) registrars' learning experience. Previous research found "upstream" (registrar previously seen patient) continuity of 43% and "downstream" (follow-up appointment arranged between registrar and patient) continuity of 49% in Australian GP registrars.

Objectives: This study aimed to assess inter-practice variability in registrar experience of continuity of care.

Methods: Cross-sectional analysis (2010-23) from the Registrar Clinical Encounters in Training study of GP registrars' in-consultation clinical experiences. Outcome factors were "upstream" and "downstream" continuity. Inter-practice variability was assessed using median odds ratios (MORs). Outcome variance attributable to practice was estimated within the Bayesian modeling framework using a mixed-effects logistic regression with cross-classified random effects for registrar and practice.

Results: The analysis included 4643 registrars (response rate 93.3%) across 978 practices. 42.5% (289 426) of registrar consults involved "upstream" continuity and 45.5% (313 295) of registrar consults involved "downstream" continuity. The MOR values were 1.47 [credible interval [CrI] (1.44, 1.50)] and 1.40 [CrI (1.38, 1.43)], for "upstream" and "downstream" continuity, respectively, in a model with random effects for practice and registrar; and 1.35 [CrI (1.32, 1.37)] and 1.38 [CrI (1.36, 1.41)], respectively, in the model adjusted for time/registrar/patient/consultation/consultation outcome/practice variables.

Conclusions: Considerable variability exists in continuity of care measures between GP training practices. This has implications for registrars' learning opportunities, particularly in chronic disease management-essential in the context of an aging population. Strategies to improve registrars' continuity of care in practices with lower rates of continuity should be considered.