Continuity of Care in Adult Asthma Patients in Izmir: A Mixed-Methods Study in a Tertiary Clinic

Abstract Background Continuity of care is a fundamental component of asthma care. However, it remains understudied in Turkiye. This study aimed to assess the prevalence of continuity of care among adult asthma patients and to identify associated factors. Methods A sequential explanatory mixed-methods design was adopted, situated within a critical realist paradigm and conceptually guided by Levesque's healthcare access framework. The first phase included a cross-sectional survey with 312 participants. Multivariable logistic regression was conducted. In the second phase, maximum variation sampling was employed. A total of 12 in-depth interviews were analysed using a critical grounded theory approach. Data saturation was reached after the eighth interview. Results Only 29.2% of participants met the criteria for continuity of care, defined by both relational and management continuity. Patients with well-controlled asthma had significantly higher odds of continuity (OR = 2.67, p = 0.007). Additional factors positively associated with continuity included receiving clear explanations (OR = 3.18, p = 0.003), absence of asthmatic first-degree relatives (OR = 1.92, p = 0.027), less appointment availability (OR = 1.86, p = 0.029), and prescription continuity (OR = 0.14, p < 0.001). Qualitative data revealed key barriers to continuity, including difficulties securing follow-up appointments, particularly with the same physician, which participants valued for patient-centred care within time-limited visits. Communication problems with healthcare providers, treatment burden, and lack of care coordination for comorbidities were reported. Participants also described experiencing stigma in various domains of life. Conclusions Continuity of care remains suboptimal among asthma patients in tertiary settings due to structural and relational barriers. Policy efforts should prioritise integration across levels of care, promote continuity in patient - provider relationships, and address determinants of access. Key messages • Continuity of care among adult asthma patients in this study is low, with only 29.2% experiencing both relational and management continuity, highlighting a critical gap in chronic care delivery. • Structural barriers, communication and coordination issues result in disrupted continuity; integrating services and fostering long-term care relationships are needed for improved asthma care.