Abstract
BackgroundContinuity, usually considered a quality aspect of primary care, is under pressure in Norway, and elsewhere.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.Design and settingRegistry-based observational study in Norway covering 4 552 978 Norwegians listed with their RGPs.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.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.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.
Highlights
Continuity is a core value of primary care
Length of regular general practitioner (RGP)–patient relationship is significantly associated with lower use of OOH services, fewer acute hospital admissions, and lower mortality
Greater continuity with a primary care physician has been shown to be associated with lower mortality rates,[3] fewer hospital admissions,[4,5] less use of emergency departments,[6] and fewer referrals for specialist health care.[7,8]
Summary
Continuity is a core value of primary care. McWhinney described continuity as an implicit contract between a patient and a GP, who takes personal responsibility for the patient’s medical needs.[1,2] Continuity is not limited by the type of disease and bridges episodes of various illnesses. There is no uniform agreement about how continuity should be defined, but three aspects are usually described: informational, longitudinal, and interpersonal.[10] Informational continuity means that the doctor has adequate access to all relevant information about the patient. Longitudinal continuity means that it transcends multiple episodes of illness, and interpersonal refers to a trustful relationship between patient and physician. Most of them are based on visit patterns with different providers over time.[10,11] An example is the Usual Provider of Care (UPC) index, which calculates the percentage of all contacts that is with the most frequent provider.[12] Most of these studies have been conducted with limited patient samples and rather short observation periods. Continuity, usually considered a quality aspect of primary care, is under pressure in Norway, and elsewhere
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