Explaining continuity in contemporary primary care: The CAP continuity theory

Objectives

Continuity is associated with improved outcomes for patients, clinicians and health systems, yet remains difficult to achieve in contemporary primary care. This study introduces CAP Continuity, an empirically grounded, realist-informed, explanatory theory that accounts for how continuity is generated or disrupted in context. CAP Continuity conceptualises continuity as emerging from the interaction of three domains—competence, attitude and provision.

Methods

A realist evaluation examined continuity for people with mesothelioma in UK general practice. Nine longitudinal patient case studies were developed using longitudinal realist interviews with patients, their healthcare professionals (n = 12) and close persons (n = 9). Analysis involved reflexive thematic coding, development of Context–Mechanism–Outcome configurations and theory refinement informed by Burden of Treatment Theory and the Candidacy Framework.

Results

CAP Continuity proposes that continuity depends on (1) competence—the capabilities of patients, close persons, and professionals to understand, navigate, coordinate, and engage with care; (2) attitude—the relational, moral, and motivational orientations that shape whether people prioritise continuity and (3) provision—the organisational and system-level arrangements that enable or constrain continuity. Continuity is most likely when these domains align; misalignment explains why continuity breaks down even when individual relationships appear strong.

Conclusions

CAP Continuity offers an explanatory structure that integrates existing definitions with attention to context, mechanisms and system conditions. Developed in the context of mesothelioma and UK general practice, the theory is transferable—subject to contextual fit—to other community-based settings where multidisciplinary care, workload and system pressures shape the possibilities for continuity.