'Continuity of care': a critical interpretive synthesis of how the concept was elaborated by a national research programme.

Introduction: A Continuity of Care Research Programme was undertaken in England in 2000-9. The Programme was informed by a conceptual framework proposed by Freeman and colleagues in an earlier scoping study. At the end of the Programme, a conceptual synthesis was carried out in order to confirm or refine the 'Freeman model' of continuity of care.

Methods: A conceptual synthesis of the outputs of the Programme, using Critical Interpretive Synthesis.

Results: The conceptual framework underpinning the Freeman model of continuity of care, which prioritises the perspectives of service users and carers, was variously utilised in the Programme. Analysis revealed indications of an emerging shift from the patient and carer 'perspectivist' paradigm of the Freeman model towards a new 'partnership' paradigm where continuity is recognised to be co-constructed by patients, families and professionals, all of whom have an active part to play in its accomplishment.

Conclusions: The projects in the Programme have advanced understanding of patients' perspectives on continuity of care and on the complex nature of this concept. At the same time, they have raised issues and reported findings which may be indicative of an emergent paradigm shift in this area of research, towards a more dynamic partnership model.