This sub-finding was both descriptive and explanatory, and there was plenty of detail in the papers. One specific concern was that part of the aim of the main study in this analysis was a partly theoretical piece, designed to look at the complexity that exists in healthcare; so the finding of complexity was partially by design. The overall assessment of confidence was low, having been downgraded by two increments due primarily to concerns over relevance and secondly methodology and adequacy. Referral and approach to care Chronic Heart Failure NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: Figure 7: Main review findings and connections between them Clear communication Referral and approach to care Chronic Heart Failure NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 9.3.3.5 Qualitative evidence summary Table 132: Summary of Evidence for Continuity Study design and sample size Findings Quality assessment No of studies contributing to the finding Design Criteria Rating Overall assessment of confidence 1a Lack of Continuity in HF Care Focus groups of HCP in care homes Interview of pt aged 65 and under Secondary analysis of pt interviews Both people with heart failure and health professionals felt that heart failure care was fragmented leading to a lack of continuity, with negative consequences for patient experience. Methodology moderate limitations MODERATE Coherence no or very minor concerns Relevance minor concerns Adequacy no or very minor concerns 1b Primary Care Interview of pt aged 65 and under Interviews of HCP Interviews of patient and care network Questionnaire to HCP People with heart failure and professionals working in heart failure care both identified that primary care, and general practitioners in particular, could provide individualised care with continuity. HF services can cause pt to lose touch with primary care and lose this continuity. 