Annals of Family Medicine: New Research Illustrates the Importance of Continuity of Care from Different Perspectives, Examining Patient Preference, Strategies for More Regular Follow-up of Chronically Ill Patients, and Effective STI Treatment

Three new studies reveal that more than 50% of primary care patients prefer to wait up to 3–4 weeks for nonurgent visits with their own physician, that structured, team-based follow-up strategies can achieve more regular care for chronically ill patients, and that delayed STI treatment practices create breaks in continuity of care.

PROVIDENCE, R.I., March 25, 2025 /PRNewswire/ -- Continuity of care—the ongoing relationship between a patient and their physician or care team working toward the shared goal of high-quality, cost-effective medical care—is considered the hallmark of family medicine and is linked to improved health care outcomes. Three new studies published in the March/April 2025 issue of Annals of Family Medicine highlight the importance of continuity of care from different perspectives, including patient preferences for appointments with their primary care physician (PCP), clinic and staff processes that promote more regular follow-up of chronically ill patients, and timely sexually transmitted infection (STI) treatment. 

Convenience or Continuity: When Are Patients Willing to Wait to See Their Own Doctor?

This study analyzed data from a cross-sectional online survey of 2,516 adult primary care patients in Michigan to examine whether patients prefer to wait longer to see their own PCP or prefer to see another clinician for faster care. Patients were presented with scenarios for different visit types and asked to choose among three options: see only their PCP, prefer their PCP but willing to see another clinician, or see the first available clinician.

Main Results

• Over one-half of patients preferred their PCP for annual checkups, chronic condition follow-up, and mental health follow-ups. Patients were willing to wait 3-4 weeks to see their PCP for sensitive exams (68.2%), new mental health concerns (58.9%), and new concerns about chronic conditions (61.1%).
• Only 7.2% of patients were willing to wait for their PCP for urgent concerns while most preferred the soonest available clinician.

"Our data demonstrate that most patients are willing to wait 3 to 4 weeks to see their own PCP for certain types of visits, underscoring the importance of seeing someone they trust over the convenience of being seen more quickly," the authors write. "As trends show an increase in the use of urgent care centers in the United States, as well as health systems prioritizing expedient access over continuity, data from our study and others suggest that these shifts do not align with patient preferences for care, or with important health outcomes such as emergency department and hospital use." 

Teamwork Among Primary Care Staff to Achieve Regular Follow-Up of Chronic Patients

This qualitative study used semi-structured interviews with primary care physicians, nurses, administrative staff, and pharmacists from 12 clinics—half with high temporal regularity (patients attending follow-ups consistently) and half with low temporal regularity to identify strategies that helped high–temporal regularity clinics maintain regular chronic care visits.

Results showed that strategies of clinics with high temporal regularity included:                     

• A clear follow-up system for "no show" patients, beginning with administrative staff reaching out to patients and ending with recruiting the help of patients' family members.
• Close working relationships within less hierarchical, flatter structures, where every team member is part of the decision-making process.
• Routine staff meetings to discuss patients who have been lost-to-follow-up, adaptive workflows, assistance with bureaucracy, informal communication channels, and consultations with social workers.

The findings from this study highlight how team-based strategies—including structured follow-up systems, proactive patient outreach, and interdisciplinary collaboration—can improve more regular follow-up and continuity of care of patients with chronic conditions.  "These strategies contributed to higher-functioning health care teams and would be worth emulating more widely by clinics looking to improve their performance," the authors write.

The STI epidemic remains a serious public health concern. From 2009 to 2022, the annual incidence of chlamydia increased by 22%and that of gonorrhea increased by 98%. This study analyzed electronic health record data from the PRIME registry, which includes information from over 2,000 primary care clinicians across the United States, to quantify the overall treatment rate for chlamydia and gonorrhea and identify factors associated with treatment delays and disparities.

Main Results: 6,678 cases of chlamydia and 2,206 cases of gonorrhea confirmed by a positive test were identified.

• 75.3% of chlamydia cases and 69.6% of gonorrhea cases were treated within 30 days.
• More than 80% of treated patients received antibiotics within 7 days of diagnosis.
• Only 14% of chlamydia cases were treated with the recommended doxycycline and only 38.7% of gonorrhea cases were treated with the recommended ceftriaxone.
• Women, young adults (ages 10-29), and suburban residents were more likely to receive treatment.
• Time to treatment of chlamydia was longer for patients aged 50-59 years and for non-Hispanic Black patients.

About 30% of patients with chlamydia or gonorrhea did not receive any treatment for their infection. For those who did receive treatment, it was delayed by a median of three days, and the antibiotics clinicians used were commonly not those recommended. Lapses in timely, standardized STI treatment—stemming from factors such as incomplete data tracking, limited electronic health record interoperability between systems, and patient challenges like not returning for follow-ups, providing incorrect contact information, treatment avoidance due to fear, and financial constraints—create significant breaks in continuity.   

"Given the importance of timely treatment for these STIs to curb the spread of infection, there remains substantial opportunity to improve treatment rates across all patient groups, with particular attention directed to those in vulnerable populations. Additional incentives may be needed to promote adherence to clinical practice guidelines and thereby ensure timely treatment and selection of the appropriate antibiotic regimen," the authors write.                   

An accompanying episode of the Annals of Family Medicine Podcast, featuring two of this study's authors, Shiying Hao, PhD, and Neil Kamdar, MA, will be available here beginning 9am EDT March 25. 

Articles Cited:

Convenience or Continuity: When Are Patients Willing to Wait to See Their Own Doctor?

Gregory Shumer, MD, MHSA1 Dongru Chen, MS; John Holkeboer; Lauren Marshall, MPH, MPP; Devon Kinney, MSQM2 Ananda Sen, PhD; Michael Klinkman, MD; Katherine J. Gold, MD, MSW, MS

Teamwork Among Primary Care Staff to Achieve Regular Follow-Up of Chronic Patients

Maram Khazen, PhD; Ligat Shalev, PhD;  Avivit Golan-Cohen, MD; Eugene Merzon, MD; Ariel Israel, MD; Shlomo Vinker, MD; Adam J. Rose, MD, MSc

Shiying Hao, PhD;  Guoyu Tao, PhD; William S. Pearson, PhD;  Ilia Rochlin, PhD; Robert L. Phillips, MD, MSPH; David H. Rehkopf, ScD, MPH; Neil Kamdar, MA

Annals of Family Medicine is an open access, peer-reviewed, indexed research journal that provides a cross-disciplinary forum for new, evidence-based information affecting the primary care disciplines. Launched in May 2003, Annals of Family Medicine is sponsored by seven family medical organizations, including the American Academy of Family Physicians, the American Board of Family Medicine, the Society of Teachers of Family Medicine, the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors, the North American Primary Care Research Group, and the College of Family Physicians of Canada. Annals of Family Medicine is published online six times each year, charges no fee for publication, and contains original research from the clinical, biomedical, social, and health services areas, as well as contributions on methodology and theory, selected reviews, essays, and editorials. Complete editorial content and interactive discussion groups for each published article can be accessed for free on the journal's website, www.AnnFamMed.org.

SOURCE Annals of Family Medicine