Article Text

Download PDFPDF

Continuity of care with doctors—a matter of life and death? A systematic review of continuity of care and mortality
  1. Denis J Pereira Gray1,
  2. Kate Sidaway-Lee1,
  3. Eleanor White1,2,
  4. Angus Thorne1,3,
  5. Philip H Evans1,2
  1. 1 St Leonard’s Practice, Exeter, UK
  2. 2 Medical School, University of Exeter, Exeter, UK
  3. 3 Medical School, University of Manchester, Manchester, UK
  1. Correspondence to Sir Denis J Pereira Gray; denis.pereiragray{at}


Objective Continuity of care is a long-standing feature of healthcare, especially of general practice. It is associated with increased patient satisfaction, increased take-up of health promotion, greater adherence to medical advice and decreased use of hospital services. This review aims to examine whether there is a relationship between the receipt of continuity of doctor care and mortality.

Design Systematic review without meta-analysis.

Data sources MEDLINE, Embase and the Web of Science, from 1996 to 2017.

Eligibility criteria for selecting studies Peer-reviewed primary research articles, published in English which reported measured continuity of care received by patients from any kind of doctor, in any setting, in any country, related to measured mortality of those patients.

Results Of the 726 articles identified in searches, 22 fulfilled the eligibility criteria. The studies were all cohort or cross-sectional and most adjusted for multiple potential confounding factors. These studies came from nine countries with very different cultures and health systems. We found such heterogeneity of continuity and mortality measurement methods and time frames that it was not possible to combine the results of studies. However, 18 (81.8%) high-quality studies reported statistically significant reductions in mortality, with increased continuity of care. 16 of these were with all-cause mortality. Three others showed no association and one demonstrated mixed results. These significant protective effects occurred with both generalist and specialist doctors.

Conclusions This first systematic review reveals that increased continuity of care by doctors is associated with lower mortality rates. Although all the evidence is observational, patients across cultural boundaries appear to benefit from continuity of care with both generalist and specialist doctors. Many of these articles called for continuity to be given a higher priority in healthcare planning. Despite substantial, successive, technical advances in medicine, interpersonal factors remain important.

PROSPERO registration number CRD42016042091.

  • continuity of care
  • mortality
  • systematic review
  • doctors
  • doctor patient relationship

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors DJPG conceived the idea for the systematic review. KS-L wrote the protocol with input from other authors and submitted it to PROSPERO. AT, EW and KS-L carried out database searches. DJPG, KS-L, AT and EW carried out article selection, data extraction and assessing article quality. PHE had the deciding vote in article selection, data extraction and assessing article quality. KS-L carried out data analysis. All authors wrote and edited the manuscript. All authors approved the manuscript for publication.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional unpublished data are available.