Access and continuity of care in primary healthcare (Embase).

Background: Over the past 20 years, there has been a policy drive in the UK to improve patients' access to appointments in primary care. It has been suggested that this increased focus on timely access to care could hinder continuity of care. The aim of this paper was to investigate how continuity of care and access to care are interrelated and their relative importance for patients and healthcare professionals. Methods: A systematic review was conducted using six academic databases (EMBASE, PubMed, Scopus, Web of Science, CINAHL and PsycINFO). In addition, reference lists of included studies and Google Scholar were searched for additional papers. Fifty-one papers were identified for inclusion in the review. Studies varied in terms of whose perspectives on continuity and access were sought, how they conceptualised access and continuity, and for quantitative studies, what measures used. We conducted a thematic analysis of the literature and used Haggerty et al.'s (2003) conceptualization of continuity and Boyle et al.'s (2020) conceptualization of access to synthesise the data. We used these findings to propose a theorisation of the access-continuity relationship. Findings: Five themes emerged from the synthesis of existing literature: system-level, practice-level and patient-level factors that influence access and continuity of care, what is important to patients, and how practices can support access and continuity of care in general practice. We found that 'choice of access' has the strongest relationship with relational continuity, however, 'physical access', in terms of the ability to get and attend an appointment (in person or remote), supersedes other dimensions of access as necessary but not sufficient for continuity of care. Conclusions: Our synthesis provides evidence that the dimensions of continuity important to patient care depend on the combination of patients' demographic characteristics and health conditions along with situational circumstances including characteristics of the health system and provider, which may be more or less changeable. We present a theoretical framework that accounts for the relationships between the different dimensions of access and continuity that can support policymakers and providers in understanding how to achieve an effective balance in providing both access and continuity for patients.