Continuity of Care: Territory and General Practitioner

Continuity of care represents a concept of paramount importance in territorial healthcare and notably in general practice. It is a concept focused on three main dimensions, namely informational, relational, and managerial continuity. It may impact on outcomes of older patients and older frail patients, even in patients pertaining to the surgery setting. An Italian model and a French model for continuity of care after hospital discharge are described. Among the strategies proven to be useful for frail older patients facing surgery, prehabilitation, comprehensive geriatric assessment, and enhanced recovery after surgery protocols play an important role. Healthcare systems need to implement hospital-to-community continuity of care pathways, considering the surgical aspect as an emerging issue alongside the “traditional” conditions of older patients.