Continuity of care: What it is and why it’s so powerful

Early on in my career, I worked in Narrogin, a small rural town two hours out of Perth.

Before working in Narrogin, I understood the concept of ‘continuity of care’ to be something that involved three elements:

  • Relational continuity – where a patient and their care providers develop ongoing relationships
  • Informational continuity – where a patient has access to information that allows for safe and coherent care
  • Management continuity – where there is consistency in how care is delivered to a patient

Continuity of care is rooted in a long-term patient-physician partnership in which the physician knows the patient’s history from experience and can integrate new information and decisions from a whole-person perspective efficiently without extensive investigation or record1.

It’s one thing to understand something conceptually, however. It’s quite another to experience that same thing. Experience adds valuable nuance to your understanding of something.

It was in Narrogin, in maternity care, that I was first able to see the benefits of continuity of care:

  • As the General Practitioner in town, I was the obstetrician, paediatrician, and counsellor. This meant I was seeing the same patients in different capacities and got to know them and their personal situations quite intimately.
  • A group of five core midwives provided our hospital maternity care. The midwives were the central hub of the community, they knew everyone in town, as such they were well-placed to identify those ‘at risk’ and make sure community support was available for those at-risk patients when they went home.
  • There seemed to be a ‘retired’ or ‘on-maternity leave’ midwife in every surrounding town looking out for lactation and other issues which meant these could be addressed early via early intervention and support.
  • Our Child Health Nurse was central in the community, and she and I had a very strong working relationship.
  • There was a strong sense of community in general. Everyone knew who had just had a baby, meals were organised, and everyone was checking in to make sure they were travelling okay.

I’ve previously written about silos in pregnancy care; how this leads to the patient having to ‘project manage’ their own care and how sub-optimal it is for patients to have to do this at a time where they are sleep-deprived and vulnerable.

Narrogin was the exact opposite of this silo situation. Information flowed freely between all the care providers in the town who were involved in maternity and postnatal care. They say it takes a village to raise a child. Narrogin was very much that village scenario.

The personal and professional experiences I had there influenced my thoughts on what maternity care should look like, and I based a lot of the One for Women model on what I learned in my time there including:

  • A midwife who sees the patient right through journey. Already patients have commented on the comfort they get from seeing a familiar face throughout the journey from their initial appointment to delivery and again in the postnatal period
  • A GP Obstetrician who sees them both antenatally and postnatally, allowing for identification of subtle changes in the patient and in-turn early intervention and improved patient care
  • Longer appointment times, allowing for the development of a relationship between the patient and our care providers
  • Allowing patients to develop a relationship with the whole team which leads to higher trust with the people delivering their care
  • A focus on sharing of information. Consolidating care providers in one location means information can be shared seamlessly between all care providers. We have smashed down the silos that have impacted on patient care previously and significantly increased our ability to deliver excellence in care.

In effect, the One for Women goal was to create a ‘village’ like the one we had in Narrogin.

What we’ve observed to date is that our approach (long consults, emphasis on building an ongoing relationship and trust):

  • Leads to more information sharing as part of our consultations.
  • Means the patient isn’t starting from scratch with every care provider from an investigative point of view. This allows for the early recognition of subtle changes.

Within the maternity setting, there is already evidence that a continuity-of-care model is more likely to lead to:

  • Lower intervention during pregnancy and labour
  • A more positive experience of labour and birth
  • Higher satisfaction with maternity care
  • Higher chance of breastfeeding

We observed all of the above with Cheryl.

She’s a 28-year-old professional who, at our first consult, requested to birth via caesarean section and indicated she intended to bottle-feed once her baby was born. I chatted with Cheryl to understand her thoughts around this and discovered she wanted to schedule the delivery around her commitments and had heard horror stories about natural delivery. It’s important to note that I made no judgements, nor did I try to change Cheryl’s mind. I told her I’d support her 100% in whichever approaches she wanted to take.

Over the course of the pregnancy, she developed trust in our relationship. As we (the One for Women team) continued to educate and provide reassurance regarding delivery, she began to consider a spontaneous labour and breastfeeding. She identified that her fears were born out of uncertainty around labour and delivery so drew on our knowledge and reassurance to become more comfortable with those feelings.

Cheryl birthed her baby vaginally at 38 and a half weeks, having gone into labour spontaneously. She breastfed successfully and made a very successful transition to parenthood.

We consider Cheryl a ‘continuity of care success story’ not because we ‘got her to change her mind’ about caesarean and bottle-feeding. It was a success because our care model allowed her to feel supported and make her choices in a more informed fashion, rather than letting fear make decisions for her.

And Cheryl is not our only success story. We are observing:

  • lower intervention during pregnancy and labour
  • a more positive experience of labour and birth
  • higher satisfaction with maternity care
  • higher chance of breastfeeding

with all of our One for Women patients currently, and believe our results will only improve as our systems become more refined over time.

The continuity of care model is important because it doesn’t just lead to better patient outcomes, it leads to better patient experience. (The importance of which I’ve shared here.) It allows for real trust and understanding to build between the patient and care providers. And allows the patient to feel like they are actively participating in their care, as opposed to being passengers being taken for a ride.

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