Table 1 Summary of study characteristics of the included studies. Results and further details are available in Additional file 5
Author Year | Study type Country | Population n | Measure of exposure (continuity) | Outcome(s) | Overall risk of bias |
|---|---|---|---|---|---|
Adair et al. 2005 | Prospective cohort study Canada, Alberta | SMI n = 486 65% mood disorders 35% psychotic disorders | Alberta Continuity of Services Scale (ACSS-MH) | EQ-5D | High |
Adnanes et al. 2019 | National cross-sectional survey Norway | SMI or non-SMI patients receiving specialist outpatient psychiatric treatment n = 155 SMI n = 835 non-SMI | Perception of COC using the CONTINUUM measure | QOL measured with the Manchester Short Assessment of Quality of Life (MANSA) questionnaire | Moderate |
Bindman et al. 2000 | Prospective cohort study England, south London | SMI n = 100 91% psychotic illness | Contact with number of community “keyworkers” over a period of time | BPRS (Brief Psychiatric Rating Scale) HoNOS (Health of the Nation Outcome Score) GAF (Global Assessment of Functioning) | Moderate |
Catty et al. 2013 | Prospective cohort study England | Psychotic disorders n = 180 | User rated overall “experienced” continuity using the CONTINUUM measure | BPRS (Brief Psychiatric Rating Scale GAF (Global Assessment of Functioning) Quality of Life - MANSA and SEQoL | High |
Chien et al. 2000 | Register study USA, Maryland | Schizophrenia n = 351 | Continuity of care (COC) Usual provider continuity (UPC) Sequential continuity (SECON) | Medicaid costs Lehman Quality of Health | Moderate |
Conti et al. 2012 | Register study Italy, Lombardy | SMI n = 11 797 42% schizophrenia 8% bipolar disorder 50% depression | Continuity of Care defined as receiving at least one psychiatric contact every 90 days | Lack of persistence with pharmacological treatment defined as a gap of at least 30 days between subsequent medication fills | Moderate |
Desai et al. 2005 | Register study from the VA health system USA | SMI with or without alcoholism, substance abuse or PTSD n = 121 933 | Continuity of outpatient of care measured as the number of two-month periods in the six months after discharge in which the patient had at least two outpatient visits for his or her primary discharge diagnosis (range = 0–3) | Suicide | Moderate |
Farley et al. 2011 | Register study USA, North Carolina | Schizophrenia n = 7 868 | Number of unique prescribers of medication for schizophrenia | Adherence to medication measured by the medication possession ratio (MPR) from Medicaid data | Moderate |
Giacco et al. 2018 | Prospective natural experiment Follow-up 1 year Belgium, England, Germany, Italy, Poland | Psychiatric in-patients 41% psychotic disorders 49% mood disorders 18% other disorders n = 7 302 | Personal continuity, i.e., a patient is under the care of the same psychiatrist for in- and out- patient treatment; or specialization, i.e., a patient is under the care of different psychiatrists for in- and out-patient treatment. | Readmission to hospital within one year following the index admission | Moderate |
Hoertel et al. 2014 | Observational study France | Patients who visited a psychiatrist at least twice over six months n = 114 515 diagnosis available for n = 2 863 17% schizophrenia 29% major depressive disorder 10% bipolar disorder 38% personality disorder | COC Index | All-cause mortality | Moderate |
Kaltsidis et al. 2020 | Retrospective observational study Canada, Quebec | Patients visiting emergency department for mental health reasons n = 210 | Exploring predictors for ED visits based on predisposing, enabling and needs factors One of the enabling factors was a regular source of care over the 12 months prior to the research interview at the emergency department | Number of visits to the emergency department for mental health reasons over the 12 months prior to the index visit | Moderate |
Macdonald et al. 2019 | Register study England, south London | Schizophrenia or delusional disorders 83% schizophrenia 17% delusional disorders n = 5 552 | Modified Continuity Index (MMCI) measuring the number of teams caring for the patient over time | Health of the Nation Outcomes Scales (HoNOS) | Moderate |
Mitton et al. 2005 | Observational study Alberta, Canada | SMI n = 486 65% mood disorders 35% psychotic disorders | Alberta Continuity of Services Scale (ACSS-MH) | Quality of Life (EQ-5D) Community functioning (Multnomah Community Ability Scale) Administrative data concerning service use events and health care costs | Moderate |
Puntis et al. 2016 | Prospective cohort study England | Patients with psychosis diagnosis who were to be discharged from compulsory hospital treatment n = 323 | Average gap between face-to-face contacts Number of 60-day gaps without contact Number of different mental health professions seen Number of care coordinators Number of psychiatrists | Readmission to hospital Time to readmission Number of days in hospital | Moderate |
Ride et al. 2019 | Observational study England | SMI 53% schizophrenia and other psychoses 35% bipolar disorder 12% both diagnoses n = 19 324 | Family physician relational continuity measured by: COC Continuity of Care UPC Usual Provider Care SECON Sequential Continuity | Emergency presentations Unplanned admissions for SMI Ambulatory care-sensitive conditions (ACSC) | Moderate |
van der Lee et al. 2016 | Retrospective register-based cohort study The Netherlands | Schizophrenia n = 7 392 | The number of follow-up years of elective psychiatric care | Acute treatment events Inpatient care and somatic care Medical costs | High |
Watkins et al. 2016 | Retrospective cohort study USA | Co-occurring mental illness (schizophrenia, bipolar disorder type 1, PTSD or depression) and substance use disorder n = 144 045 | Continuous care over time defined as receiving ≥ 1 visit each quarter over a one-year period from any type of provider | Mortality after 12 and 24 months after the end of the observation period (main outcome) Avoidable excessive mortality number | Moderate |