Abstract
BackgroundStudies of Primary Health Care (PHC) reveal considerable practice variations in terms of the range of services provided. In Norway, general practitioners (GPs) are traditionally expected to perform IUD-insertions and several surgical procedures as a part of comprehensive PHC. We aimed to investigate variation in the provision of surgical procedures and IUD-insertions across GPs and over time and explore determinants of such variation.MethodsRetrospective registry study of Norwegian GPs. From a comprehensive database of GPs’ reimbursement claims, we obtained procedure codes and GP characteristics such as age, gender, list size and municipality characteristics from 2006 through 2013. Multivariable logistic regression models were fitted to explore determinants of practice variation.ResultsWe extracted data from 4,828 GPs. In 2013, 91.0, 76.1 and 74.8% were reimbursed at least once for minor and major surgical procedures and IUD-insertion, respectively. Female GPs had lower odds for performing major surgical procedures (OR 0.38, 95% CI 0.32–0.45) and higher odds for performing IUD-insertions (OR 6.28, 95% CI 4.47–8.82) than male GPs. Older GPs and GPs with shorter patient lists were less likely to perform surgical procedures. GPs with longer patient lists had higher odds for performing IUD-insertions. The proportion of GPs performing surgical procedures increased over time, while the proportion decreased for IUD-insertions. The number of IUD-insertions in specialist care increased from 12,575 in 2011 to 15 216 (+21.0%) in 2014.ConclusionWe observed a large variation in the provision of surgical procedures and IUD-insertions amongst GPs in Norway. The GPs’ age, gender, list size and size of municipality were associated with performing the procedures. Our findings suggest a shift of IUD-insertions from primary to specialist care.
Highlights
Studies of Primary Health Care (PHC) reveal considerable practice variations in terms of the range of services provided
Subjects From the The Norwegian Health Economic Administration (HELFO) database we identified all General practitioner (GP) working in daytime surgeries from 2006 through 2013 (n = 5218)
To restrict code 100 to minor surgical procedures performed by GPs themselves, we only included claims in which code 100 was accompanied with 149a, the code for local anaesthesia, which is expected to be performed simultainously
Summary
Studies of Primary Health Care (PHC) reveal considerable practice variations in terms of the range of services provided. Health care researchers have shown large variations in the utilization of various health services within countries and regions. As some of these variations are sizeable, concerns have been raised regarding the quality and equity in the delivery of health care [1,2,3]. Wide variations in referral rates are seen in countries with a GP gatekeeping function. This variation is largely unexplained some of it may reflect patient and GPs preferences [8,9,10,11].
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