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Vinjerui KH, Asheim A, Sarheim Anthun K, Carlsen F, Mjølstad BP, Nilsen SM, Pape K, Bjørngaard JH. General practitioners retiring or relocating and its association with healthcare use and mortality: a cohort study using Norwegian national data. BMJ Qual Saf 2024:bmjqs-2023-017064. [PMID: 39060027 DOI: 10.1136/bmjqs-2023-017064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 06/26/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Continuity in the general practitioner (GP)-patient relationship is associated with better healthcare outcomes. However, few studies have examined the impact of permanent discontinuities on all listed patients when a GP retires or relocates. AIM To investigate changes in the Norwegian population's overall healthcare use and mortality after discontinuity due to Regular GPs retiring or relocating. METHODS Linking national registers, we compared days with healthcare use and mortality for matched individuals affiliated with Regular GPs who retired or relocated versus continued. We included list patients 3 years prior to exposure and followed them up to 5 years after. We assessed changes over time employing a difference-in-differences design with Poisson regression. RESULTS From 2011 to 2020, we identified 819 Regular GPs retiring and 228 moving, affiliated with 1 165 295 people. Relative to 3 years before discontinuity, the rate ratio (RR) of daytime GP contacts, increased 3% (95% CI 2 to 4) in year 1 after discontinuity, corresponding to 148 (95% CI 54 to 243) additional contacts per 1000 patients. This increase persisted for 5 years. Out-of-hours GP contacts increased the first year, RR 1.04 (95% CI 0.99 to 1.09), corresponding to 16 (95% CI -5 to 37) contacts per 1000 patients. Planned hospital contacts increased 3% (95% CI 2 to 4) in year 1, persisting into year 5. Acute hospital contacts increased 5% (95% CI 3 to 7), primarily in the first year. These 1-year effects corresponded to 51 (95% CI 18 to 83) planned and 13 (95% CI 7 to 18) acute hospital contacts per 1000 patients. Mortality was unchanged up to 5 years after discontinuity. CONCLUSION Regular GPs retirement and relocation were associated with small to moderate increases in healthcare use among listed patients, while mortality was unaffected.
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Affiliation(s)
- Kristin Hestmann Vinjerui
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Andreas Asheim
- Center for Health Care Improvement, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
- Department of Mathematical Sciences, Faculty of Information Technology and Electrical Engineering, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Fredrik Carlsen
- Department of Economics, Faculty of Economics and Management, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Bente Prytz Mjølstad
- General Practice Research Unit, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Sara Marie Nilsen
- Center for Health Care Improvement, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Kristine Pape
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Johan Håkon Bjørngaard
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- Faculty of Nursing and Health Sciences, Nord university, Levanger, Norway
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Bogh SB, Fløjstrup M, Morsø L, Søndergaard J, Brabrand M, Birkeland S. Importance of GP contact on readmission rate following psychiatric acute care: A Danish Nationwide study. Gen Hosp Psychiatry 2024; 90:44-49. [PMID: 38936298 DOI: 10.1016/j.genhosppsych.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 06/12/2024] [Accepted: 06/12/2024] [Indexed: 06/29/2024]
Abstract
Insufficient acute psychiatric care substantially impacts patient well-being and healthcare quality. Early readmissions after discharge from psychiatric care are common, and preventing these is important for the patients as well as appropriate resource allocation. The relationship between post-discharge general practitioner (GP) contact and readmission rates remains to be explored, as does the association between pre-hospital GP contact and post-discharge engagement. AIM This study examines post-discharge GP contact and its association with outpatient revisits and inpatient readmissions among unplanned psychiatric hospital contacts, including the impact of pre-visit GP contact on post-discharge care within 14 days. METHODS Utilizing data from the Danish healthcare system (2019-2023), unplanned psychiatric hospital contacts and subsequent 14-day GP encounters were analyzed. RESULTS Of 298,085 unplanned psychiatric hospital contacts, 12.6% had a 14-day revisit as an outpatient and 13.6% had a 14-day readmission as an inpatient. During regular business hours, GP contact was associated with a decreased risk of unplanned outpatient revisits (HR 0.45, 95% CI 0.44-0.47) and inpatient readmissions (HR 0.43, 95% CI 0.41-0.44). Similarly, utilizing GP on-call services was linked to a reduced risk of unplanned revisits (HR 0.87, 95% CI 0.81-0.94) and readmissions (HR 0.81, 95% CI 0.76-0.87). Having a GP contact within two days before an unplanned psychiatric hospital contact increased the likelihood of having a GP contact within 14 days post-discharge. CONCLUSION Post-discharge GP encounters were associated with lower rates of 14-day outpatient revisits and inpatient readmissions following unplanned psychiatric hospital contacts. GP contact before psychiatric hospital contact enhances attendance at post-discharge appointments, suggesting a potential efficacy of promoting GP appointments for mental health care.
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Affiliation(s)
- Søren Bie Bogh
- Department of Clinical Medicine, Faculty of Health Sciences, University of Southern Denmark and Open Patient Data Explorative Network, Odense University Hospital, J. B. Winsløws Vej 21, 3. sal, 5000 Odense, Denmark.
| | - Marianne Fløjstrup
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark, Campusvej 55, 5230 Odense M
| | - Lars Morsø
- Department of Clinical Medicine, Faculty of Health Sciences, University of Southern Denmark and Open Patient Data Explorative Network, Odense University Hospital, J. B. Winsløws Vej 21, 3. sal, 5000 Odense, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark, Campusvej 55, 5230 Odense M
| | - Mikkel Brabrand
- Department of Clinical Medicine, Faculty of Health Sciences, University of Southern Denmark and Department of Emergency Medicine, Odense University Hospital, Odense C, Denmark, J. B. Winsløws Vej 4, 5000 Odense
| | - Søren Birkeland
- Forensic Mental Health Research Unit, Middelfart, Faculty of Health Science, Department of Regional Health Research, University of Southern Denmark, Denmark and Open Patient Data Explorative Network, Odense University Hospital, Denmark, J. B. Winsløws Vej 21, 3. sal, 5000 Odense
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Pahlavanyali S, Hetlevik Ø, Baste V, Blinkenberg J, Hunskaar S. Continuity of care and mortality for patients with chronic disease: an observational study using Norwegian registry data. Fam Pract 2023; 40:698-706. [PMID: 37074143 PMCID: PMC10745252 DOI: 10.1093/fampra/cmad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Research on continuity of care (CoC) is mainly conducted in primary care and has received little acknowledgment in other levels of care. This study sought to investigate CoC across care levels for patients with selected chronic diseases, along with its association with mortality. METHODS In a registry-based cohort study, patients with ≥1 consultation in primary or specialist healthcare or hospital admission with asthma, chronic obstructive pulmonary disease (COPD), diabetes mellitus, or heart failure in 2012 were linked to disease-related consultation data in 2013-2016. CoC was measured by Usual Provider of Care index (UPC) and Bice-Boxermann continuity of care score (COCI). Values equal to one were categorized into one group and the rest into three equal groups (tertiles). The association with mortality was determined by Cox regression models. RESULTS The highest mean UPCtotal was measured for patients with diabetes mellitus (0.58) and the lowest for those with asthma (0.46). The population with heart failure had the highest death rate (26.5). In adjusted Cox regression analyses for COPD, mortality was 2.6 times higher (95% CI 2.25-3.04) for patients in the lowest tertile of continuity compared to those with UPCtotal = 1. Patients with diabetes mellitus and heart failure showed similar results. CONCLUSION CoC was moderate to high for disease-related contacts across care levels. A higher mortality associated with lower CoC was observed for patients with COPD, diabetes mellitus, and heart failure. A similar, but not statistically significant trend was found for patients with asthma. This study suggests that higher CoC across levels of care can decrease mortality.
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Affiliation(s)
- Sahar Pahlavanyali
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Øystein Hetlevik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Valborg Baste
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - Jesper Blinkenberg
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - Steinar Hunskaar
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
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Olsen JK, Wehberg S, Waldorff FB, Henriksen DP, Lykkegaard J. Variation in daytime general practice services and association with out-of-hours use for older patients: protocol for a Danish cohort study. BMJ Open 2023; 13:e073229. [PMID: 37500276 PMCID: PMC10387735 DOI: 10.1136/bmjopen-2023-073229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION Out-of-hours primary care services cannot provide the same continuity and coordination of care as general practice. Thus, patients with high risk of complex care trajectories should, when possible, be treated by the general practitioner during daytime opening hours. This study aims to analyse the variation among general practices in the frequencies of daytime services for persons aged ≥75 years and how it relates to the patients' use of out-of-hours services. METHODS AND ANALYSIS Register-based cohort study of all Danish citizens aged ≥75 years, of whom >98% are listed with a general practice. Using Poisson regression, we will estimate each practice's excess variation in delivered daytime services compared with the expected based on the characteristics of its listed patients. Delivered daytime services will be analysed overall and separately for face-to-face, phone, email, home visit and preventive services. The association with the use of out-of-hours services will be analysed by Poisson regression. ETHICS AND DISSEMINATION Complying with European data protection rules, the legal services at University of Southern Denmark (Research & Innovation Organisation) approved the data processing activities regarding this project (journal number 11.593). According to section 14.2 of the Act on Research Ethics Review of Health Research Projects, because the study is based solely on register data, approval from the ethics committee and informed consent are not required. Results from the study will be disseminated as publications in peer-reviewed scientific journals and at international conferences.
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Affiliation(s)
- Jonas K Olsen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Sonja Wehberg
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Frans Boch Waldorff
- Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Jesper Lykkegaard
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Vinjerui KH, Sarheim Anthun K, Asheim A, Carlsen F, Mjølstad BP, Nilsen SM, Pape K, Bjorngaard JH. General practitioners ending their practice and impact on patients' health, healthcare use and mortality: a protocol for national registry cohort studies in Norway, 2008 to 2021. BMJ Open 2023; 13:e072220. [PMID: 37433723 DOI: 10.1136/bmjopen-2023-072220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
INTRODUCTION Continuous general practitioner (GP) and patient relations associate with positive health outcomes. Termination of GP practice is unavoidable, while consequences of final breaks in relations are less explored. We will study how an ended GP relation affects patient's healthcare utilisation and mortality compared with patients with a continuous GP relation. METHODS AND ANALYSIS We link national registries data on individual GP affiliation, sociodemographic characteristics, healthcare use and mortality. From 2008 to 2021, we identify patients whose GP stopped practicing and will compare acute and elective, primary and specialist healthcare use and mortality, with patients whose GP did not stop practicing. We match GP-patient pairs on age and sex (both), immigrant status and education (patients), and number of patients and practice period (GPs). We analyse the outcomes before and after an ended GP-patient relation, using Poisson regression with high-dimensional fixed effects. ETHICS AND DISSEMINATION This study protocol is part of the approved project Improved Decisions with Causal Inference in Health Services Research, 2016/2159/REK Midt (the Regional Committees for Medical and Health Research Ethics) and does not require consent. HUNT Cloud provides secure data storage and computing. We will report using the STROBE guideline for observational case-control studies and publish in peer-reviewed journals, accessible in NTNU Open and present at scientific conferences. To reach a broader audience, we will summarise articles in the project's web page, regular and social media, and disseminate to relevant stakeholders.
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Affiliation(s)
- Kristin Hestmann Vinjerui
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kjartan Sarheim Anthun
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Health Research, SINTEF Digital, Trondheim, Norway
| | - Andreas Asheim
- Center for Health Care Improvement, Trondheim University Hospital, Trondheim, Norway
- Department of Mathematical Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Fredrik Carlsen
- Department of Economics, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bente Prytz Mjølstad
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sara Marie Nilsen
- Center for Health Care Improvement, Regionalt senter for helsetjenesteutvikling, St. Olavs hospital, Trondheim, Norway
| | - Kristine Pape
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Johan H Bjorngaard
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
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Ansems SM, Ganzevoort IN, van Tol DG, Fokkema T, Olthof M, Berger MY, Holtman GA. Qualitative study evaluating the expectations and experiences of Dutch parents of children with chronic gastrointestinal symptoms visiting their general practitioner. BMJ Open 2023; 13:e069429. [PMID: 37192810 DOI: 10.1136/bmjopen-2022-069429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
OBJECTIVES Chronic gastrointestinal symptoms are common among children and affect their daily activities and quality of life. The majority will be diagnosed with a functional gastrointestinal disorder. Effective reassurance and education are, therefore, key components of the physician's management. Qualitative studies have shown how parents and children experience specialist paediatric care, yet less is known about general practitioners (GPs), who manage most cases in the Netherlands and have a more personal and enduring relationship with their patients. Therefore, this study evaluates the expectations and experiences of parents of children visiting a GP for chronic gastrointestinal symptoms. DESIGN We conducted a qualitative interview study. Online interviews were audio and video recorded, transcribed verbatim and independently analysed by the first two authors. Data were collected and analysed concurrently until data saturation was reached. Using thematic analysis, we developed a conceptual framework reflecting respondent expectations and experiences. We performed a member check of the interview synopsis and the conceptual framework. SETTING Dutch primary care. PARTICIPANTS We purposively sampled participants from a randomised controlled trial evaluating the effectiveness of faecal calprotectin testing in children with chronic gastrointestinal complaints in primary care. Thirteen parents and two children participated. RESULTS Three key themes emerged: disease burden, GP-patient relationship and reassurance. Often, the experienced disease burden and the pre-existing GP-patient relationship influenced expectations (eg, for further investigations or a sympathetic ear), and when a GP fulfilled these expectations, a trusting GP-patient relationship ensued that facilitated reassurance. We found that individual needs influenced these themes and their interrelationships. CONCLUSION Insights provided by this framework could help GPs managing children with chronic gastrointestinal symptoms in daily practice and may therewith improve the consultation experience for parents. Further research should evaluate whether this framework also holds true for children. TRIAL REGISTRATION NUMBER NL7690.
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Affiliation(s)
- Sophie M Ansems
- Department of Primary and Long-term Care, University Medical Center Groningen, Groningen, The Netherlands
| | - Ilse N Ganzevoort
- Department of Primary and Long-term Care, University Medical Center Groningen, Groningen, The Netherlands
| | - Donald G van Tol
- Department of Primary and Long-term Care, University Medical Center Groningen, Groningen, The Netherlands
- Department of Sociology, Faculty of Behavioral and Social Sciences, University Medical Center Groningen, Groningen, The Netherlands
| | - Tryntsje Fokkema
- Department of Primary and Long-term Care, University Medical Center Groningen, Groningen, The Netherlands
| | - Marijke Olthof
- Department of Primary and Long-term Care, University Medical Center Groningen, Groningen, The Netherlands
| | - Marjolein Y Berger
- Department of Primary and Long-term Care, University Medical Center Groningen, Groningen, The Netherlands
| | - Gea A Holtman
- Department of Primary and Long-term Care, University Medical Center Groningen, Groningen, The Netherlands
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Pahlavanyali S, Hetlevik Ø, Blinkenberg J, Hunskaar S. Continuity of care for patients with chronic disease: a registry-based observational study from Norway. Fam Pract 2022; 39:570-578. [PMID: 34536072 PMCID: PMC9295609 DOI: 10.1093/fampra/cmab107] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Continuity of care (CoC) is accepted as a core value of primary care and is especially appreciated by patients with chronic conditions. Nevertheless, there are few studies investigating CoC for these patients across levels of healthcare. OBJECTIVE This study aims to investigate CoC for patients with somatic chronic diseases, both with regular general practitioners (RGPs) and across care levels. METHODS We conducted a registry-based observational study by using nationwide consultation data from Norwegian general practices, out-of-hours services, hospital outpatient care, and private specialists with public contracts. Patients with diabetes mellitus (type I or II), asthma, chronic obstructive pulmonary disease, or heart failure in 2012, who had ≥2 consultations with these diagnoses during 2014 were included. CoC was measured during 2014 by using the usual provider of care (UPC) index and Bice-Boxerman continuity of care score (COCI). Both indices have a value between 0 and 1. RESULTS Patients with diabetes mellitus comprised the largest study population (N = 79,165) and heart failure the smallest (N = 4,122). The highest mean UPC and COCI were measured for patients with heart failure, 0.75 and 0.77, respectively. UPC increased gradually with age for all diagnoses, while COCI showed this trend only for asthma. Both indices had higher values in urban areas. CONCLUSIONS Our findings suggest that CoC in Norwegian healthcare system is achieved for a majority of patients with chronic diseases. Patients with heart failure had the highest continuity with their RGP. Higher CoC was associated with older age and living in urban areas.
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Affiliation(s)
- Sahar Pahlavanyali
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Øystein Hetlevik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Jesper Blinkenberg
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - Steinar Hunskaar
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
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Walderhaug KE, Nyquist MK, Mjølstad BP. GP strategies to avoid imaging overuse. A qualitative study in Norwegian general practice. Scand J Prim Health Care 2022; 40:48-56. [PMID: 35188069 PMCID: PMC9090343 DOI: 10.1080/02813432.2022.2036480] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 11/12/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES The aim of the study was to identify general practitioners' (GPs) strategies to avoid unnecessary diagnostic imaging when encountering patients with such expectations and to explore how patients experience these strategies. DESIGN, SETTING AND SUBJECTS We conducted a qualitative study that combined observations of consultations and interviews with GPs and patients. A total of 24 patients visiting nine different GPs in two Norwegian urban areas were included in the study. Of these, 12 consultations were considered suitable for studying GP strategies and were therefore selected for a more thorough analysis. MAIN OUTCOME MEASURES GPs' communication strategies to avoid unnecessary medical imaging and patients' experiences with such strategies. RESULTS Five categories of strategies were identified: (1) wait and see - or suggest an alternative; (2) the art of rejection; (3) seek support from a professional authority; (4) partnership and shared decision-making and (5) reassurance, normalisation and recognition. The GPs often used multiple strategies. Factors related to a long-term doctor-patient relationship seemed to influence both communication and how both parties experienced the decision. Three important factors were evident: the patient trusted the doctor, the doctor knew the patient's medical history and the doctor knew the patient as a person. The patients seemed to be generally satisfied with the outcomes of the consultations. CONCLUSION GPs largely combine different strategies when meeting patients' expectations of diagnostic imaging that are not strictly medically indicated. Continuity of the doctor-patient relationship with good personal knowledge and trust between doctor and patient appeared crucial for patients to accept the doctors' decisions.Key pointsGPs usually combine a broad range of strategies to avoid unnecessary medical imagingThe patients appeared generally satisfied regardless of the strategy the strategy used by the GPs and even where their referral request were rejectedFactors related to a long-term doctor-patient relationship appeared decisive.
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Affiliation(s)
| | | | - Bente Prytz Mjølstad
- General Practice Research Unit, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
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Sandvik H, Hetlevik Ø, Blinkenberg J, Hunskaar S. Continuity in general practice as predictor of mortality, acute hospitalisation, and use of out-of-hours care: a registry-based observational study in Norway. Br J Gen Pract 2022; 72:e84-e90. [PMID: 34607797 PMCID: PMC8510690 DOI: 10.3399/bjgp.2021.0340] [Citation(s) in RCA: 99] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/20/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Continuity, usually considered a quality aspect of primary care, is under pressure in Norway, and elsewhere. AIM To analyse the association between longitudinal continuity with a named regular general practitioner (RGP) and use of out-of-hours (OOH) services, acute hospital admission, and mortality. DESIGN AND SETTING Registry-based observational study in Norway covering 4 552 978 Norwegians listed with their RGPs. METHOD Duration of RGP-patient relationship was used as explanatory variable for the use of OOH services, acute hospital admission, and mortality in 2018. Several patient-related and RGP-related covariates were included in the analyses by individual linking to high-quality national registries. Duration of RGP-patient relationship was categorised as 1, 2-3, 4-5, 6-10, 11-15, or >15 years. Results are given as adjusted odds ratio (OR) with 95% confidence intervals (CI) resulting from multilevel logistic regression analyses. RESULTS Compared with a 1-year RGP-patient relationship, the OR for use of OOH services decreased gradually from 0.87 (95% CI = 0.86 to 0.88) after 2-3 years' duration to 0.70 (95% CI = 0.69 to 0.71) after >15 years. OR for acute hospital admission decreased gradually from 0.88 (95% CI = 0.86 to 0.90) after 2-3 years' duration to 0.72 (95% CI = 0.70 to 0.73) after >15 years. OR for dying decreased gradually from 0.92 (95% CI = 0.86 to 0.98) after 2-3 years' duration, to 0.75 (95% CI = 0.70 to 0.80) after an RGP-patient relationship of >15 years. CONCLUSION Length of RGP-patient relationship is significantly associated with lower use of OOH services, fewer acute hospital admissions, and lower mortality. The presence of a dose-response relationship between continuity and these outcomes indicates that the associations are causal.
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Affiliation(s)
- Hogne Sandvik
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen
| | - Øystein Hetlevik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen
| | - Jesper Blinkenberg
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen; Department of Global Public Health and Primary Care, University of Bergen, Bergen
| | - Steinar Hunskaar
- NORCE Norwegian Research Centre, Bergen; Department of Global Public Health and Primary Care, University of Bergen, Bergen
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