Continuity in general practice as predictor of mortality, acute hospitalisation, and use of out-of-hours care: a registry-based observational study in Norway
Continuity, usually considered a quality aspect of primary care, is under pressure in Norway, and elsewhere. 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. Reg...
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| Veröffentlicht in: | British journal of general practice Jg. 72; H. 715; S. e84 |
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| Sprache: | Englisch |
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01.02.2022
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| Abstract | Continuity, usually considered a quality aspect of primary care, is under pressure in Norway, and elsewhere.
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.
Registry-based observational study in Norway covering 4 552 978 Norwegians listed with their RGPs.
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.
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.
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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| AbstractList | Continuity, usually considered a quality aspect of primary care, is under pressure in Norway, and elsewhere.BACKGROUNDContinuity, usually considered a quality aspect of primary care, is under pressure in Norway, and elsewhere.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.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.Registry-based observational study in Norway covering 4 552 978 Norwegians listed with their RGPs.DESIGN AND SETTINGRegistry-based observational study in Norway covering 4 552 978 Norwegians listed with their RGPs.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.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.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.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.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.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. Continuity, usually considered a quality aspect of primary care, is under pressure in Norway, and elsewhere. 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. Registry-based observational study in Norway covering 4 552 978 Norwegians listed with their RGPs. 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. 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. 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. |
| Author | Blinkenberg, Jesper Sandvik, Hogne Hunskaar, Steinar Hetlevik, Øystein |
| Author_xml | – sequence: 1 givenname: Hogne surname: Sandvik fullname: Sandvik, Hogne organization: National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen – sequence: 2 givenname: Øystein surname: Hetlevik fullname: Hetlevik, Øystein organization: Department of Global Public Health and Primary Care, University of Bergen, Bergen – sequence: 3 givenname: Jesper surname: Blinkenberg fullname: Blinkenberg, Jesper organization: National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen; Department of Global Public Health and Primary Care, University of Bergen, Bergen – sequence: 4 givenname: Steinar surname: Hunskaar fullname: Hunskaar, Steinar organization: NORCE Norwegian Research Centre, Bergen; Department of Global Public Health and Primary Care, University of Bergen, Bergen |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/34607797$$D View this record in MEDLINE/PubMed |
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| References | 35902267 - Br J Gen Pract. 2022 Jul 28;72(721):373. doi: 10.3399/bjgp22X720257. 38154953 - Br J Gen Pract. 2023 Dec 28;74(738):11-12. doi: 10.3399/bjgp24X735909. 36823071 - Br J Gen Pract. 2023 Feb 23;73(728):108. doi: 10.3399/bjgp23X732093. |
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To analyse the association between longitudinal... Continuity, usually considered a quality aspect of primary care, is under pressure in Norway, and elsewhere.BACKGROUNDContinuity, usually considered a quality... |
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| Title | Continuity in general practice as predictor of mortality, acute hospitalisation, and use of out-of-hours care: a registry-based observational study in Norway |
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