Continuity of Care for All ? Influence of patients’ socioeconomic status on the exposure to specialised and personal continuity of care

Smith, Pierre [UCL] Nicaise, Pablo [UCL] Wyngaerden, François [UCL] Bourmorck, Delphine [UCL] Molera Gui, Maria [UCL] Lorant, Vincent [UCL]

Aim: In several countries, there is a debate to decide whether, after discharge from psychiatric stay, continuity of care is best when organised by one clinician (personal continuity of care) or by different clinicians (specialised continuity of care). These two options coexist in several countries, but they may not be accessible to all socio-economic groups. We sought to investigate if patients with lower socioeconomic status (SES) received the same continuity of care than those with higher status. Method: Within the European study COFI, data on 1773 psychiatric, hospitalised patients, allocated either to specialised or personal care continuity, were collected in UK, Germany, Italy, Poland and Belgium. Patient’s SES was assessed at 1-year follow-up with measures of objective socioeconomic status (OSS) and subjective social status (SSS). Results: Globally, patients had an intermediate SSS (mean score 4.7/10, SD 2.1). SSS measures are correlated to OSS measures. Low SSS and unemployment were independently associated with an increase of the likelihood of being allocated to personal continuity of care, but severity of disorder was not. In the final adjusted model, only unemployment remains associated. Conclusions: Although results are consistent with the literature in terms of severity of disorders, exposure to continuity of care options is mainly determine by SES, in favour to personal continuity of care for the least wealthy patients. Therefore, this may have an impact on access to specialised care for the most socially deprived patients.