Provider continuity of care and quality of the cancer diagnostic processes in general practice

Background

Provider continuity of care (PCoC) is a core feature of general practice. Although most cancer diagnostic pathways start in primary care, evidence on the role of PCoC in the diagnostic process is limited. We examine the association between PCoC and general practitioners’ (GPs) retrospective assessments of the quality of cancer diagnostic processes in general practice, and whether these associations vary by symptom presentation, education, and multimorbidity.

Methods

We combined survey data from 187 Danish general practices with registry data on 5,663 cancer patients diagnosed in 2019–2021. PCoC was measured as the number of different GPs and practice staff involved from the first cancer-related contact to referral. Logistic regression models estimated odds ratios (ORs) for poor quality assessments using two PCoC measures: individual-level PCoC (model 1) and practice-level PCoC based on other cancer patients in the same clinic (model 2). Models were adjusted for sociodemographic and clinical factors, with model 2 additionally accounting for practice-level patient composition.

Results

Seeing multiple GPs or practice staff was associated with higher odds of poor quality assessments for both women and men (model 1). Most of these associations disappeared in model 2; however, men attending clinics with the highest average number of encountered GPs (OR 1.58; 95% CI 1.05–2.37) or practice staff (OR 1.72; 95% CI 1.13–2.64) had increased odds of a poor assessment. Among women, higher odds of a poor assessment of the GP’s role were observed in clinics with the lowest GP-related PCoC (model 2). Associations were most pronounced among men with low education and multimorbidity.

Conclusions

Lower PCoC in the cancer diagnostic process was associated with poorer GP-assessed quality. Practice-level PCoC appeared particularly relevant for specific patient subgroups, suggesting that primary care organization may matter in cancer diagnostic pathways.

Key messages

• Lower provider continuity of care during the cancer diagnostic process is associated with poorer GP‑assessed quality of the diagnostic process in general practice.

• Practice-level continuity may be particularly relevant for vulnerable patient groups, indicating the role of primary care organization in cancer diagnostics.