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November 2, 1984

Continuity Counts

Author Affiliations

Massachusetts General Hospital Boston

JAMA. 1984;252(17):2459. doi:10.1001/jama.1984.03350170061024

Continuity of care is one of those values that no one actually opposes but that is, nonetheless, often sacrificed quietly, usually in the name of convenience or efficiency. There are powerful forces making continuity of care increasingly difficult to achieve. Subspecialization fragments care. Third-party payment structures provide few incentives to support primary care givers developing strong patient relationships over time. Much of our health care system is discontinuous. Multiple levels of health care facilities hinder continuity of care. Urbanization and mobility also work against continuity of medical care. The American health consumer may even be placing convenience before continuity. The rapidly growing chains of medical walk-in centers entice consumers with advertisements of speed and convenience. The fast-food style of providing medical care is the antithesis of continuity of care. Even in more traditional settings, continuity of care may be difficult to achieve when patients see multiple specialists, often on self-referral.