Continuity in general practice as predictor of mortality, acute hospitalisation, and use of out-of-hours care: a registry-based observational study in Norway

Abstract

BackgroundContinuity, usually considered a quality aspect of primary care, is under pressure in Norway, and elsewhere.AimTo 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 settingRegistry-based observational study in Norway covering 4 552 978 Norwegians listed with their RGPs.MethodDuration 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.ResultsCompared 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.ConclusionLength 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.

Psychosocial care responses to terrorist attacks: a country case study of Norway, France and Belgium

“…European guidelines for post-disaster psychosocial prescribe a similar “stepped care” model [ 22 , 25 , 91 ]. Within such a model, a regular GP, for instance, may facilitate the coordination and continuity of care, and research indicates that long-lasting patient relationships with a regular GP are associated with positive health-related outcomes [ 92 , 93 ]. The regular GP may further have an overview of the affected individuals’ prior health problems and social situation, which may be valuable in post-disaster follow-up.…”

Reasons for acute referrals to hospital from general practitioners and out-of-hours doctors in Norway: a registry-based observational study

“…Continuity of care in general practice may help in this task. Length of patient continuity with a named regular GP is associated with lower use of OOH services, fewer hospital admissions and even lower mortality [32].…”

Editorial: Core Values and Tasks of Primary Care in Changing Communities and Health Care Systems

“…Substantial body of research and literature confirms the general value of FM as the foundation of any health care system. Welldeveloped FM is associated with more cost-effective health care and better health (9)(10)(11). Some of these studies focus on the core value "Continuity of care."…”

“…Substantial body of research and literature confirms the general value of FM as the foundation of any health care system. Well-developed FM is associated with more cost-effective health care and better health ( 9 – 11 ). Some of these studies focus on the core value “Continuity of care.” In 2018, Pereira Gray and co-workers presented a systematic review of studies from nine countries across medical disciplines, concluding that continuity of care was associated with lowered mortality rates ( 10 ).…”