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Continuity in primary care: a critical but neglected component for achieving high-quality universal health coverage
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  • Published on:
    Continuity in primary care: application and implications for trauma-informed care
    • Nomi C. Levy-Carrick, physician (psychiatry) Brigham and Women's Hospital, Harvard Medical School
    • Other Contributors:
      • Annie Lewis-O'Connor, nurse-scientist
      • Eve Rittenberg, physician (primary care)
      • Samara Grossman, social worker
      • Hanni M. Stoklosa, physician (emergency medicine)

    The recent study by Dan Schwartz and colleagues, Continuity in primary care: a critical but neglected component for achieving high-quality universal health coverage (2019) provides a valuable framework for optimizing primary care. The focus on continuity as one of the “Starfield ‘4C’ functions of effective primary care aligns strongly with those of trauma-informed care in an adult medical setting. The tension between continuity and access is acknowledged as reality, but not an obstacle, to expansion of access to care.

    The three core domains of relational, informational and managerial continuity described by Schwarz and team correlate strongly to the six trauma-informed care guiding principles: trust and trustworthiness, physical and psychological safety; collaboration and mutuality, empowerment, voice and choice, peer support, and cultural, historical and gender acknowledgment. These principles are grounded in the 4R’s of an organizational culture that includes: (1) realization of the ubiquity of trauma, (2) recognition of the ways in which trauma affects all individuals in the organization: patients and their families, clinicians and staff, (3) response through integration of knowledge about trauma into policies and procedures, and (4) avoidance of re-traumatizing patients and staff.

    Trauma-informed care is above all a resilience-focused approach, and primary care remains central to primary and secondary prevention in public health. Given the overall sh...

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    Conflict of Interest:
    None declared.