The recognition of discontinuity of care has led to different initiatives in the healthcare system over the years (e.g., facilitating communication via the electronic medical record, improving patient education, and/or introducing discharge planning), but the active role that patients themselves play is typically overlooked.Īccordingly, in contrast to much research on continuity and discontinuity of care, which has largely focused on how discontinuity is resolved (and continuity established) from a provider or organizational perspective, this research invites patients to consider what discontinuities they experience, and how they (attempt to) resolve them. Continuity and discontinuity of care should not be viewed as rigid opposites, but as two ends of a spectrum: care experiences may tend, to a greater or lesser extent, towards one end. Furthermore, discontinuity along the management dimension refers to circumstances in which patients receive care from different providers that is not connected in a coherent way. The importance of (ongoing) relationships between patients and providers is captured in the relational dimension: relational discontinuity refers to the absence of such relationships. Discontinuity along the informational dimension refers to a lack of relevant patient information amongst different care providers (e.g., on prior events), but also includes deficits in the care provider’s knowledge about the patient’s preferences, values, and context. Patients’ experiences of continuity and discontinuity can be understood along three dimensions: informational, relational and management. Accordingly, by understanding the discontinuities that patients experience, and considering these as opportunities to reestablish continuity, healthcare systems may optimize their approaches towards increasingly specialized patient care. Meanwhile, research has convincingly shown that boundaries are not insurmountable and offer opportunities for change. These boundaries are typically considered as relatively impermeable barriers to communication and coordination, and undeniably lead to discontinuity of care with occasionally severe consequences (e.g., psychological distress or medical errors with higher rates of hospitalization). Patients are required to navigate between different care providers, but experience boundaries between them. Continuity of care is threatened as a consequence. Yet, as a result of specialization, patients experience a lack of coordination that integrates the care provided by different care providers. Because of complex needs, they receive consultation and treatment from multiple healthcare specialties.

Patients requiring substantive specialized care are often treated by different care providers.

Nvivo transcribing