The use of remote and digital primary care could be making it more difficult to achieve continuity of care, according to an analysis published today.

Research published in the British Journal of General Practice said continuity in primary care is important but little is known about expanding remote and digital care models in primary care have impacted this. Dr Emma Ladds and colleagues from the University of Oxford examined in detail 15 studies that explored how remote and digital approaches to care have impacted continuity and said they came to three tentative conclusions. The first is that using remote and digital modalities makes it more difficult to achieve continuity when compared with face-to-face encounters.

The authors said the loss of continuity seems to affect certain groups – in particular those who value an ongoing relationship with an individual GP, such as older, vulnerable patients or those with more complex medical issues. They add that if a clinician already had an ongoing relationship with a patient, it is easier to maintain digitally / remotely, but it is harder to develop a relationship if they have never met in person.

Dr Ladds said: “Continuity is an important cornerstone of general practice that has become more challenging to achieve with the widespread use of remote and digital approaches to primary care today. It is essential to consider (and further research) what practices and processes can best support continuity, particularly for older, complex, or more vulnerable patients, in order to ensure we continue to enjoy the numerous benefits continuity offers individuals and the wider healthcare system.”

The researchers identified relevant English-language qualitative and quantitative studies from any country between 2000 and 2022, which explored remote or digital approaches in primary care and continuity. Out of the 5,501 identified, they included 15 studies in the review. The specific impact of remote approaches on continuity was rarely addressed. While some patients expressed a preference for relational continuity, others prioritised access. Clinicians valued continuity, with some viewing remote consultations more suitable where there was high episodic or relational continuity. With lower continuity, patients and clinicians considered remote consultations harder, higher risk, and poorer quality. Some evidence suggested remote approaches and/or their implementation risked worsening inequalities and causing harm by reducing continuity where it was valuable. If used strategically and flexibly, remote approaches could improve continuity, the studies found.