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Observational Study
. 2022 Jan 27;72(715):e84-e90.
doi: 10.3399/BJGP.2021.0340. Print 2022 Feb.

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

Hogne Sandvik  1 , Øystein Hetlevik  2 , Jesper Blinkenberg  3 , Steinar Hunskaar  4
Affiliations
Observational Study

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

Hogne Sandvik et al. Br J Gen Pract. .

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.

Keywords: Norway; continuity of patient care; emergency medical services; family practice; general practice; hospitalisation; mortality.

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Figures

Figure 1.
Figure 1.
Associations between continuity measured as years with the same RGP and odds for use of OOH services, acute hospital admissions, and mortality during 2018. OOH = out-of-hours. OR = odds ratio.
See this image and copyright information in PMC

Comment in

  • Personal lists are not impractical. Look at Norway!
    Sayers LD. Sayers LD. Br J Gen Pract. 2022 Jul 28;72(721):373. doi: 10.3399/bjgp22X720257. Print 2022 Aug. Br J Gen Pract. 2022. PMID: 35902267 Free PMC article. No abstract available.
  • Who is your doctor?
    Sayers LD. Sayers LD. Br J Gen Pract. 2023 Feb 23;73(728):108. doi: 10.3399/bjgp23X732093. Print 2023 Mar. Br J Gen Pract. 2023. PMID: 36823071 Free PMC article. No abstract available.
  • Realistic not romantic - real-world continuity in action.
    Sayers LD, Richardson S, Colvin D, Pearson J, Davidson E, Berry H, Harman H, Marr D, Harrison S. Sayers LD, et al. Br J Gen Pract. 2023 Dec 28;74(738):11-12. doi: 10.3399/bjgp24X735909. Print 2024 Jan. Br J Gen Pract. 2023. PMID: 38154953 Free PMC article. No abstract available.

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