How does general practitioner discontinuity affect healthcare utilisation? An observational cohort study of 2.4 million Norwegians 2007–2017

Abstract

ObjectivesPatients may benefit from continuity of care by a personal physician general practitioner (GP), but there are few studies on consequences of a break in continuity of GP. Investigate how a sudden discontinuity of GP care affects their list patients’ regular GP consultations, out-of-hours consultations and acute hospital admissions, including admissions for ambulatory care sensitive conditions (ACSC).DesignCohort study linking person-level national register data on use of health services and GP affiliation with data on GP activity and GP characteristics.SettingPrimary care.Participants2 409 409 Norwegians assigned to the patient lists of 2560 regular GPs who, after 12 months of stable practice, had a sudden discontinuity of practice lasting two or more months between 2007 and 2017.Primary and secondary outcome measuresMonthly GP consultations, out-of-hours consultations, acute hospital admissions and ACSC admissions in periods during and 12 months after the discontinuity, compared with the 12-month period before the discontinuity using logistic regression models.ResultsAll patient age groups had a 3%–5% decreased odds of monthly regular GP consultations during the discontinuity. Odds of monthly out-of-hours consultations increased 2%–6% during the discontinuity for all adult age groups. A 7%–9% increase in odds of ACSC admissions during the period 1–6 months after discontinuity was indicated in patients over the age of 65, but in general little or no change in acute hospital admissions was observed during or after the period of discontinuity.ConclusionsModest changes in health service use were observed during and after a sudden discontinuity in practice among patients with a previously stable regular GP. Older patients seem sensitive to increased acute hospital admissions in the absence of their personal GP.

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

“…A recent study from Norway demonstrated that even short breaks in continuity entailed increases in use of OOH services and admissions for ambulatory care-sensitive conditions. 38 More research is needed on what measures may be undertaken to promote stability of RGPs.…”

Continuity of care for patients with chronic disease: a registry-based observational study from Norway

“… 20 Previous Norwegian studies focus on continuity with RGPs and have demonstrated that CoC is associated with decreased hospital readmissions 21 and reduced utilization of specialist care. 22 , 23 Despite the known benefits of CoC, we have scarce evidence on CoC for patients with chronic diseases in Norway, a group of patients anticipated to especially benefit from CoC.…”

Qualitative study evaluating the expectations and experiences of Dutch parents of children with chronic gastrointestinal symptoms visiting their general practitioner

“…Our findings support the importance of these follow-up consultations to parents and children, not only making them feel that the GP acknowledged their disease burden but also strengthening their relationship. Hence, a planned follow-up consultation is an important step in creating an enduring doctor–patient relationship, which is a core principle of general practice that has various positive effects on both patient health and healthcare costs 36–39…”

“…Hence, a planned follow-up consultation is an important step in creating an enduring doctor-patient relationship, which is a core principle of general practice that has various positive effects on both patient health and healthcare costs. [36][37][38][39] To the best of our knowledge, there is no other study in which parents and children were interviewed about their expectations and experiences of a GP consultation when the child has chronic GI symptoms. This is important because, in a gatekeeping system such as that in the Netherlands, the GP is the first physician to see a child with chronic GI symptoms and will typically manage most cases without referral to secondary care.…”