Associations between primary healthcare and unplanned medical admissions in Norway: a multilevel analysis of the entire elderly population

Abstract

Objective: To examine if individual risk of unplanned medical admissions (UMAs) was associated with municipality general practitioner (GP) or long-term care (LTC) volume among the entire Norwegian elderly population.

Design: Cross-sectional population-based study.

Setting: 428 of 430 Norwegian municipalities in 2009.

Participants: All Norwegians aged ≥65 years (n=721 915; 56% women-15% of the total population).

Main outcome measure: Individual risk of UMA.

Results: Using a multilevel analytical framework, consisting of individuals (N=722 464) nested within municipalities (N=428), nested within local hospital areas (N=52) we found no association between municipality GP or LTC volume and UMAs. However, we found that higher LTC levels of provision were associated with fewer hospitalisations among the older age groups. A modest geographical variability was observed for UMA in adjusted analysis.

Conclusions: A higher primary healthcare volume was only associated with fewer UMAs among the oldest old in a universally accessible healthcare system.

Keywords: Long-term Care; Primary Care; Small Area Analyses; Unplanned Admissions.

Figure 1

Predicted differences (log OR) of UMAs by LTC quartiles and age group (model 7). Men and women aged 65 years and older, Norway, 2009. Reference category in each age group are individuals living in municipalities with the lowest LTC level (Q1 LTC; log odds=0, dashed line). LTC, long-term care; UMAs, unplanned medical admissions.