Table 1 Characteristics of included studies assessing the quality of continuous relationships between patients and providers in primary care grouped by inclusion criteria and in alphabetical order of first author

 Burge et al. (2011) [14]

Canada

To examine how well relational continuity is measured in validated instruments that evaluate primary healthcare from the patient’s perspective.

N/A – Review of validated questionnaire and subscales

Relational continuity

Therapeutic relationship

Validated questionnaires

Primary Care Assessment Survey

Primary Care Assessment Tool (short form)

Components of Primary Care Index

 Haggerty et al. (2012) [15]

Canada

To develop and validate a generic measure of management continuity from the patient perspective.

Patients who had received care for an ongoing health condition at more than one clinic in the previous 12 months.

Relational continuity

Questionnaire (being validated)

Generic measure of continuity of care

 Harley (2009) [16]

England

To adapt the Components of Primary Care Index (CPCI) to be applicable to oncology outpatients and to assess the reliability and validity of the adapted instrument (renamed the Medical Care Questionnaire [MCQ]).

Outpatient cancer patients ≥18 years of age.

Continuity of care

Coordination of care

Questionnaire

Medical Care Questionnaire

 Hill et al. (2014) [17]

England

To determine the suitability of the Primary Care Assessment Tool as a measure of continuity of care for patients with a long-term condition (stroke), and co-morbidity, in a primary care setting.

Community living stroke survivors (12 months post stroke)

Continuity of care

Relational continuity

Questionnaire

Chao Perception of Continuity Scale

 Jatrana (2011) [18]

New Zealand

To construct a summary measure of continuity of care

Randomly sampled individuals, aged ≥15 years, who completed Statistics New Zealand-led Survey of Family, Income and Employment (SoFIE) survey

Continuity of care

4 questions identified from the PCAT

Primary Care Assessment Tool

 Uijen (2011) [20]

Netherlands

To develop and pilot test a generic questionnaire to measure continuity of care from the patient’s perspective across primary and secondary care settings.

Patients aged > 18 years, with at least one chronic illness, literate in Dutch.

Patient provider relationship

Personal continuity

Questionnaire (being validated)

Nijmegen continuity questionnaire

 Uijen (2012) [40]

Netherlands

To further examine the validity, discriminative ability, and reliability of the Nijmegen continuity questionnaire.

Patients aged > 18 years, with at least one chronic illness, literate in Dutch.

Continuity of care

Personal continuity

Quality of care

Questionnaire (being validated)

Nijmegen continuity questionnaire

 Zenger (2014) [21]

Germany

To assess the internal and external validity of the German version of the PDRQ-9 in a representative cross-sectional German population

Randomly selected individuals, ≥14 years of age, literate in German, who had visited a PCP.

Patient-doctor relationship, therapeutic alliance,

Validated questionnaire

Patient Doctor Relationship Questionnaire (PDQR-9)

 Al-Azri et al. (2014) [22]

Oman

To study the role of relational continuity in primary care settings and its effect on patients’ perceptions and experiences.

Patients aged > 18 years attending their PCHCs during the study period

Relational continuity

Non-validated questionnaire

N/A

 Bryan et al. (2012) [24]

United States of America

To identify the impact of very early therapeutic alliance on the general trajectory of change for suicidal ideation among patients seen within the context of an integrated primary care behavioural health service.

Patients with mental health concerns, receiving a referral from their primary care provider to an Air-Force hospital based Behavioural Health Consultant.

Therapeutic alliance

Validated questionnaire

Therapeutic Bond Scale

 Corso et al. (2012) [25]

United States of America

To investigate therapeutic alliance and clinical improvement within an integrated primary care behavioural health model

Patients with mental health concerns receiving a referral from their primary care provider to an Air-Force hospital based Behavioural Health Consultant.

Therapeutic alliance

Validated questionnaire

Therapeutic Bond Scale

 Falkenström et al. (2013) [26]

Sweden

Test whether high alliance scores after a consultation predicts lower symptom scores immediately before the next consultation

Patients aged 18–70 years, attending a health service and receiving treatment with psychologist, social worker or counsellor

Therapeutic alliance

Validated questionnaire

Working Alliance Inventory, short form (revised)

 Ferrer et al. (2014) [27]

Brazil

To compare two offered care models in relation to longitudinality care, from the users’ perspective, and to correlate this finding to the utilisation of PHC services among patients hospitalised due to preventable conditions.

Children aged 0–14 years, attending paediatric ward of Sao Paulo hospital during the study period

Longitudinally of care

Care continuity

Validated questionnaire

Primary Care Assessment Tool (child version)

 Hansen (2016) [28]

Norway

To explore how women with CFS/ME experience GP care regarding informational, management, and relational continuity.

Members of the Norwegian Myalgic Encephalomyelitis association, experiencing Chronic Fatigue Syndrome

Relational continuity

Non-validated questionnaire

N/A

 Hernandez, A. et al. (2013)a [29]

Spain / Catalonia

To determine patients’ perceived degree of continuity of care between primary and secondary care and to identify contextual and individual factors that influence patients’ perceptions of continuity of care.

Patients ≥18 years of age who had received primary and secondary care in Catalonia within the previous 3 months.

Relational continuity

Validated Questionnaire

Care Continuity Across Levels of Care Scale (CCAENA)

 Hernandez, A. et al. (2013)b [30]

Spain / Catalonia

To compare immigrants’ and natives’ perceptions of relational, managerial and informational continuity of care and to explore the influence of the length of stay on perceptions of continuity.

Patients ≥18 years of age who had received primary and secondary care in Catalonia within the previous 3 months.

Relational continuity

Validated Questionnaire

Care Continuity Across Levels of Care Scale (CCAENA)

 Hernandez, A. et al. (2013)c [31]

Spain / Catalonia

To provide additional evidence on the psychometric properties the scales of this questionnaire.

Patients ≥18 years of age who had received primary and secondary care in Catalonia within the previous 3 months.

Patient–primary care provider relationship, Continuity across care

Validated Questionnaire

Care Continuity Across Levels of Care Scale (CCAENA)

 Hernandez, A. et al. (2013)d [31]

Spain / Catalonia

To analyse patient’s reported elements of relational, informational and managerial (dis)continuity between primary and outpatient secondary care and to identify associated factors.

Patients ≥18 years of age who had received primary and secondary care in Catalonia within the previous 3 months.

Relational (dis)continuity

Validated Questionnaire

Care Continuity Across Levels of Care Scale (CCAENA)

 Hernandez, SE. et al. (2016) [33]

United States of America

To estimate if the degree of PACT (Patient Alignment Care Teams) implementation at a facility varied with the percentage of minority veteran patients at the facility.

Primary care facilities and

Continuity of care

Validated Questionnaire

Primary Care Assessment Tool (Pi2 – provider tool)

 Jahromi (2017) [34]

Iran

To determine the continuity of health care in urban health centres in Iran

Patients and family physicians from participating primary care centres

Interpersonal continuity of care

Validated questionnaire

Primary Care Evaluation Tool (PCET)

 Kristjansson (2013) [6]

Canada

To assess whether there was a difference in the continuity of care provided by different models of primary care

Health professionals and patients ≥18 years of age, cognitively intact and not acutely ill

Continuity of care

Relational continuity

Validated questionnaire

Primary Care Assessment Tool (PCAT)

 Liu (2017) [35]

China

To understand the relationship preferences of primary care patients and their associations with patient experience of continuity of care.

Patients aged ≥18 years attending a community health clinic in Beijing, and not acutely ill.

Continuity of care

Relational continuity

Continuing relationship

Validated questionnaire

Care Continuity Across Levels of Care Scale (CCAENA)

 Merriel (2015) [36]

United Kingdom

To assess whether differences in the depth of relationship between a patient and their GP affects the length of consultations, and the number and type of problems and issues raised during a consultation.

Patients aged ≥18 years with a PHP appointment at a participating primary care clinic.

Patient-doctor continuity

Patient-doctor relationship

Validated questionnaire

Patient-Doctor Depth of Relationship

 Uijen (2012) [19]

Netherlands

To explore heart failure patients’ experiences with continuity of care, and its relation to medication adherence.

Primary care patients with chronic heart failure, literate in Dutch, no terminal diagnosis, and no mental impairment.

Continuity of care

Personal continuity

Non-validated Questionnaire

N/A

 Uijen (2014) [37]

Netherlands

To explore the level of experienced continuity of care of patients at risk for depression in primary care, and compare these to those of patients with heart failure

Patients with diagnosed depression or heart failure within the last 12 months, literate in Dutch, no terminal diagnosis, and no mental impairment.

Continuity of care

Personal continuity

Questionnaire (adapted abut not re-validated)

Nijmegen Continuity Questionnaire (Brief version)

 Wei (2015) [38]

China

To assess changes in the quality of primary care in two megacities following the introduction of health system reforms in China.

Patients aged ≥18 years, attending community health centres in Shenzhen, or Shanghai

Long-term relationships between patients and general practitioners Continuity

Questionnaire (adapted but not re-validated)

Primary Care Assessment Tool (Chinese translation)