Abstract
BackgroundLittle is known about variations in the provision of chronic care services in primary care.AimTo describe the frequency of chronic care services provided by GPs and analyse the extent of non-random variation in service provision.Design and settingNationwide cohort study undertaken in Denmark using data from 2016.MethodInformation on chronic care services was obtained from national health registers, including annual chronic care consultations, chronic care procedures, outreach home visits, and talk therapy. The associations between services provided, patient morbidity, and socioeconomic factors were estimated. Service variations were analysed, and excess variation related to practice-specific factors was estimated while accounting for random variation.ResultsChronic care provision was associated with increasing patient age, increasing number of long-term conditions, and indicators of low socioeconomic status. Variation across practices ranged from 1.4 to 128 times more than expected after adjusting for differences in patient population and random variation. Variation related to practice-specific factors was present for all the chronic care services that were investigated. Older patients with lower socioeconomic status and multimorbidity were clustered in practices with low propensity to provide certain chronic care services.ConclusionChronic care was provided to patients typically in need of health care, that is, older adults, those with multimorbidity, and those with low socioeconomic status, but service provision varied more than expected across practices. GPs provided slightly fewer chronic care services than expected in practices where many patients with multimorbidity and low socioeconomic status were clustered, suggesting inverse care law mechanisms.
Highlights
Modern healthcare is challenged by a significant burden from long-term chronic conditions that accumulate over time and lead to the development of multiple chronic conditions, or multimorbidity
Chronic care provision was associated with increasing patient age, increasing number of long-term conditions, and indicators of low socioeconomic status
Chronic care was provided to patients typically in need of healthcare, i.e. the old, those with multimorbidity, and those with low socioeconomic status, but service provision varied more than expected across practices
Summary
Modern healthcare is challenged by a significant burden from long-term chronic conditions that accumulate over time and lead to the development of multiple chronic conditions, or multimorbidity. Increasing numbers of middle-aged and elderly people are living with multimorbidity, adding significantly to the need for chronic care.[1,2] In the Danish healthcare system (Box 1), general practitioners (GPs) provide most chronic care for long-term conditions at the community level; this model ensures a high degree of continuity of care, which is valued by patients and known to improve health outcomes.[3,4,5,6,7,8,9] Chronic care provision may vary among GP practices This could reflect differences in the patient population served, e.g. morbidity level, patient age profiles, and socioeconomic status. Excess variation related to practice-specific factors was estimated while accounting for random variation
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