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Continuity of care is lower for diverse ethnic groups, study shows

by Beth Gault
7 October 2022

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Continuity of care is lower for Black, Pakistani and Bangladeshi ethnic groups compared to those of white ethnicity, according to a study published in the BJGP.

The research analysed almost 400,000 patients in England from January 2016 to December 2019 and their continuity of care using two different indexes.

It found that the ethnic inequalities were not accounted for by socioeconomic deprivation and were seen both among those with and without long-term conditions.

But, the study noted that factors leading to potential lower continuity of care, such as under-funding, ‘under-doctoring’ relative to need, and area-level socioeconomic deprivation are ‘unequally distributed across ethnic groups’.

‘These are manifestations of structural racism,’ the authors said.

‘The persistence of the association between ethnicity and continuity even after statistically controlling for area deprivation indicates that additional pathways may be operating.

‘Racism may have additional effects on continuity of care through differences in the way that people from ethnic minority groups are treated in GP practices or experience barriers in living near and accessing the highest level of GP services.’

Continuity of care is valued by both patients and GPs, the authors noted, with lower continuity of care potentially contributing to poorer outcomes for those with multiple long-term conditions. However, they said this was not directly tested in this study.

‘Given the established associations between continuity of care and adverse outcomes including higher mortality, unplanned admissions and complications, further analysis is required to test and quantify continuity as a possible link between ethnicity and these outcomes,’ the authors wrote.  

The study concluded that further research was also needed to identify initiatives that could improve services to better meet the needs of ethnic minorities.

It comes after a study suggested that continuity of care should be added as a new quality indicator to try and improve patient satisfaction in primary care services.