General Practitioner Contacts Research Articles

Obesity, cardiovascular risk and healthcare resource utilization in the UK.

Obesity and cardiovascular diseases (CVDs) often co-occur, likely increasing the intensity of healthcare resource utilization (HCRU). This retrospective, observational database study examined the joint effect of obesity and cardiovascular risk status on HCRU and compared HCRU between body mass index (BMI) categories and CVD-risk categories in the UK. Patient demographics and data on CVD and BMI were obtained from the UK Clinical Practice Research Datalink. Cardiovascular risk status, calculated using the Framingham Risk Equation, was used to categorize people into high-risk and low-risk groups, while a CVD diagnosis was used to define the established CVD group. Patients were split into BMI categories using the standard World Health Organization classifications. For each CVD and BMI category, mean number and costs of general practitioner contacts, hospital admissions and prescriptions were estimated. The final study population included 1,600,709 patients. Data on CVD status were available on just over one-quarter of the sample (28.6%) and BMI data for just less than half (43.2%). The number of general practitioner contacts and prescriptions increased with increasing BMI category for each of the three CVD-risk groups. The group with established CVD had the greatest utilization of all components of healthcare resource, followed by high CVD risk then low CVD-risk groups. Increasing BMI category and CVD-risk status both affected several HCRU components. These findings highlight the importance of timely obesity management and treatment of CVD-risk factors as a means of preventing increasing HCRU.

Predictive values of lung cancer alarm symptoms in the general population: a nationwide cohort study

We aimed to firstly determine the 1-year predictive values of lung cancer alarm symptoms in the general population and to analyse the proportion of alarm symptoms reported prior to diagnosis, and secondly analyse how smoking status and reported contact with general practitioners (GPs) regarding lung cancer alarm symptoms influence the predictive values. The study was a nationwide prospective cohort study of 69,060 individuals aged ≥40 years, randomly selected from the Danish population. Using information gathered in a survey regarding symptoms, lifestyle and healthcare-seeking together with registry information on lung cancer diagnoses in the subsequent year, we calculated the predictive values and likelihood ratios of symptoms that might be indicative of lung cancer. Furthermore, we analysed how smoking status and reported contact with GPs regarding the alarm symptoms affected the predictive values. We found that less than half of the patients had reported an alarm symptom six months prior to lung cancer diagnosis. The positive predictive values of the symptoms were generally very low, even for patients reporting GP contact regarding an alarm symptom. The highest predictive values were found for dyspnoea, hoarseness, loss of appetite and for current heavy smokers. The negative predictive values were high, all close to 100%. Given the low positive predictive values, our findings emphasise that diagnostic strategies should not focus on single, specific alarm symptoms, but should perhaps focus on different clusters of symptoms. For patients not experiencing alarm symptoms, the risk of overlooking lung cancer is very low.

Associations between lifestyle, erectile dysfunction and healthcare seeking: a population-based study

Objective: To investigate associations between age, lifestyle and erectile dysfunction (ED) in the general population and to explore associations between age, lifestyle and contact with a general practitioner (GP) regarding ED.Design: Cross-sectional web-based questionnaire study.Setting: The general Danish population.Subjects: A randomly selected sample of 48,910 men aged 20 years and older.Main outcome measures: Prevalence of ED and probability of contacting a GP regarding ED. In logistic regression models we analysed associations between age, smoking status, alcohol consumption, body mass index (BMI), and self-rated physical fitness on both ED and GP contact.Results: A total of 22,198 men (47.6%) completed the question regarding ED. The overall prevalence of ED was 19.3%, varying from 2.3% among men aged 20–29 years to 55.3% among men aged 80 years and above. 31.8% of men reporting ED had contacted a GP regarding ED. Increasing age, current or former smoking, complete alcohol abstinence or alcohol consumption above seven units per week, high BMI, and poor self-rated physical fitness were significantly associated with reporting ED. The proportion of GP contacts was significantly associated with age. Overall, no significant associations between lifestyle and healthcare seeking were observed, although lower odds of GP contact were found when physical fitness was rated as poor.Conclusion: Reporting ED and GP contact were significantly associated with age. Furthermore, lifestyle was significantly associated with reporting ED, but largely not associated with healthcare seeking. These findings are important for future interventions aiming to improve diagnosis and treatment of ED.Key pointsExperiencing erectile dysfunction is frequent in the general population, especially among older men. • In this large-scale national survey, age and lifestyle were significantly associated with reporting erectile dysfunction. • Healthcare seeking with erectile dysfunction was significantly associated with age, but not with lifestyle. • Diagnosis and treatment of erectile dysfunction might be challenged when erectile dysfunction does not lead to healthcare seeking.

Earlier palliative home care is associated with patient-centred medical resource utilisation and lower costs in the last 30 days before death in COPD: a population-level decedent cohort study

COPD patients often use many medical resources, such as hospital admissions and medical imaging, inappropriately close to death. Palliative home care (PHC) could beneficially affect this. The aim was to study the effect of use and timing of PHC on medical resource use and costs in the last 30 days before death (DBD) for COPD.We performed a retrospective study of all Belgian decedents in 2010-2015 with COPD and a primary cause of death being COPD or cardiovascular diseases. Odds ratios for medical resources were calculated between using and four PHC timing categories (>360, 360-181, 180-91 and 90-31 DBD) versus not using. Confounders were socio-demographic, care intensity and disease severity variables.Of the 58 527 decedents with COPD, 644 (1.1%) patients received PHC earlier than 30 DBD. Using PHC (versus not using) decreased the odds ratio for hospitalisation (0.35), intensive care unit admission (0.16), specialist contacts (0.58), invasive ventilation (0.13), medical imaging including chest radiograph (0.34), sedatives (0.48) and hospital death (0.14). It increased the odds ratio for home care (3.27), general practitioner contact (4.65), palliative care unit admission (2.61), noninvasive ventilation (2.65), gastric tube (2.15), oxygen (2.22) and opioids (4.04) (p<0.001). Mean total healthcare costs were €1569 lower for using PHC. All PHC timing categories showed a benefit in medical resource use and costs. However, we observed the largest benefit in the category PHC 90-31 DBD.Health policy and services should focus on increasing PHC access, while research should further explore early PHC initiation for COPD.

Non-specific Health complaints and self-rated health in pre-adolescents; impact on primary health care use

The objective of the present study was to explore past and future primary health care use in preadolescents reporting frequent non-specific health complaints or a low self-rated health compared to that of preadolescents with no frequent health complaints or with good self-rated health. The study was conducted as a cohort study based within the Danish National Birth Cohort (1996–2002). Information on non-specific health complaints and self-rated health was obtained by an 11-year follow-up questionnaire. Information about number of general practitioner (GP) contacts was obtained from the Health Insurance Service Register. A total of 44,877 pre-adolescents gave complete exposure information. Pre-adolescents who reported frequent non-specific health complaints had a higher use of GP compared to pre-adolescents without complaints across the five years following the index date (somatic complaints: IRR = (1.46 [1.38; 1.55], mental complaints: IRR = 1.16 [1.12; 1.19], both complaints: IRR = 1.58 [1.47; 1.69]). The same pattern was found for the association between low self-rated health and number of GP contacts (IRR = 1.41 (1.36; 1.46)). Non-specific health complaints and a poor self-rated health in pre-adolescents was associated with a higher past and future use of GP, indicating a need for development of early interventions with help for symptom management.

Effect Modification of Multimorbidity on the Association Between Regularity of General Practitioner Contacts and Potentially Avoidable Hospitalisations.

Scheduled regular contact with the general practitioner (GP) may lower the risk of potentially avoidable hospitalisations (PAHs). Despite the high prevalence of multimorbidity, little is known about its effect on the relationship between regularity of GP contact and PAHs. To investigate potential effect modification of multimorbidity on the relationship between regularity of GP contact and probability of PAHs. A retrospective, cross-sectional study. 229,964 individuals aged 45years and older from the 45 and Up Study in New South Wales, Australia, from 2009 to 2015. The main exposure was regularity of GP contact (capturing dispersion of GP contacts); the outcomes were PAHs evaluated by unplanned hospitalisations, chronic ambulatory care sensitive condition (ACSC) hospitalisations and unplanned chronic ACSC hospitalisations. Multivariable logistic regression models and population attributable fractions (PAF) were conducted to identify effect modification of multimorbidity, assessed by Rx-Risk comorbidity score. Compared with the lowest quintile of regularity, the highest quintile had significantly lower predicted probability of unplanned admission (- 79.9 per 1000 people at risk, 95% confidence interval (CI) - 85.6; - 74.2), chronic ACSC (- 6.07 per 1000 people at risk, 95%CI - 8.07; - 4.08) and unplanned chronic ACSC hospitalisation (- 4.68 per 1000 people at risk, 95%CI - 6.11; - 3.26). Effect modification of multimorbidity was observed. Specifically, the PAF among people with no multimorbidity indicated that 31.7% (95%CI 28.7-34.4%) of unplanned, 36.4% (95%CI 25.1-45.9%) of chronic ACSC and 48.9% (95%CI 32.9-61.1%) of unplanned chronic ACSC hospitalisation would be reduced by a shift to the highest quintile of regularity. However, among people with 10+ morbidities, the proportional reduction was only 5.2% (95%CI 3.8-6.5%), 9.0% (95%CI 0.5-16.8%) and 17.8% (95%CI 5.4-28.5%), respectively. Weakening of the association between regularity and PAHs with increasing levels of multimorbidity suggests a need to improve primary care support to prevent PAHs for patients with multimorbidity.

Frequent attenders in the German healthcare system: determinants of high utilization of primary care services. Results from the cross-sectional German health interview and examination survey for adults (DEGS)

BackgroundIn Germany, patients are consulting general practitioners increasingly frequently, resulting in a high burden on the healthcare system. This study aimed to identify factors associated with frequent primary care attendance in the German healthcare system.MethodsThe German Health Interview and Examination Survey for Adults (DEGS) is part of Germany’s national health monitoring, and includes a large representative sample of the German population aged 18–79 years. We defined the 10% of participants with the highest number of general practitioner contacts in the preceding 12 months as frequent attenders of primary care services. Binary logistic regression models with average marginal effects were used to identify potential determinants for frequent use of primary care services.ResultsThe sample comprised 7956 participants. Significant effects on frequent use of primary care were observed for low socioeconomic status, stressful life events, factors related to medical need for care such as medically diagnosed chronic conditions and for subjective health. In the full model, the number of non-communicable diseases and subjective health status had the strongest effect on frequent primary care use. We found an interaction effect suggesting that the association between subjective health status and frequent attendance vanishes with a higher number of non-communicable diseases.ConclusionsWe observed strong associations between frequent primary care attendance and medical need for care as well as subjective health-related factors. These findings suggest that better coordination of care may be a preferred method to manage health services utilization and to avoid redundant examinations and uncoordinated clinical pathways. Further research is needed to clarify moderating and mediating factors contributing to high utilization of primary care services.

Cost-consequence analysis of self-administration of medication during hospitalization: a pragmatic randomized controlled trial in a Danish hospital setting.

Objectives:The objective of this study was to evaluate the costs and consequences of introducing "self-administration of medication" (SAM) during hospitalization as compared with nurse-led dispensing and administration of medication.Methods:This pragmatic randomized controlled trial was performed in a Danish Cardiology Unit. Patients ⩾18 years old capable of self-administering medication were eligible. In the intervention group, patients self-administered their medication. In the control group, medication was dispensed and administered by nurses. The implementation of SAM was used to evaluate the cost–consequences. The micro-costing analysis used the hospital perspective and a short-term incremental costing approach. The costs for medication, materials, and nursing time were included. Consequences included the dispensing error proportion, patients’ perceptions regarding medication, satisfaction, and deviations in the medication list at follow-up. In addition, the number of readmissions and general practitioner (GP) contacts within 30 days after discharge was included.Results:The total cost (TC) per patient in the intervention group was 49.9€ (95% CI: 46.6–53.2) compared with 52.6€ (95% CI: 46.6–58.6) in the control group. The difference between the groups was not statistically significant (p = 0.09). Sensitivity analysis consistently showed TCs favoring the intervention. The dispensing error proportion was 9.7% (95% CI: 7.9–11.6) in the intervention group compared with 12.8% (95% CI: 10.9–15.6) in the control group. The difference was statistically significant (p = 0.02). The analysis also found changes in the perceptions regarding medication (indicating higher medication adherence), increased satisfaction, and fewer patients with deviations in the medication list at follow-up. No statistically significant differences between the groups in relation to readmissions and GP contacts within 30 days were observed.Conclusions:SAM seems to cost less although the cost difference was small and not statistically significant. As SAM had positive effects on patient outcomes, the results indicate that SAM may be cost-effective.Plain language summary Self-administration of medication: a research study of the costs and consequences Objectives To evaluate the costs and consequences of introducing “self-administration of medication” (SAM) during hospitalization compared to medication dispensed by nurses. Methods This research study included patients ≥18 years capable of self-administering medication and was performed in a Danish cardiology unit. Patients self-administered their own medication during hospitalization in the intervention group, whereas nurses dispensed and administered the medication in the control group. Patients were allocated between groups by randomization. The costs of SAM were analyzed from a hospital perspective and included costs for medication, materials, and nursing time. The consequences included the proportion of dispensing errors, patients’ perceptions regarding medication, patient satisfaction, deviations in the medication list at follow-up, the number of readmissions and general practitioner (GP) contacts within 30 days after discharge. Results The total cost per patient was 49.9€ in the intervention group compared to 52.6€ in the control group (p = 0.09). The cost difference between groups was not significant. The proportion of dispensing errors was significantly lower in the intervention group compared to the control group. In addition the research study found changes in the perceptions regarding medication, increased satisfaction, and fewer patients with deviations in the medication list at follow-up. For readmissions and GP contacts within 30 days no significant differences between groups were found. Conclusion SAM cost less or equal to medication dispensing and administration by nurse. SAM had positive impacts on patient outcomes. Therefore, SAM may be cost-effective.

Doctors in secondary schools program: the first year of program implementation in a rural Victorian school.

Lifelong health behaviour habits are often consolidated in adolescence, with primary health care an important element of current and future health and wellbeing. Barriers to adolescent primary healthcare access are complex and include social, behavioural and geographical issues as well as organisational and systemic barriers. This article describes the first year of implementation of a Doctors in Secondary School program in a rural setting in Victoria, Australia. The program provided 332 primary healthcare appointments over 10 months, equating to 102.33 hours of general practitioner contact with students. The program offered scheduled and unscheduled (drop-in) appointments with above-average consultation times. Cancellations and 'no-shows' were low, at 9% overall. Health promotion resources, material and information, were sourced and provided by the clinic practice nurse. The role of the practice nurse has been instrumental in providing a needs-based service for students, connecting to local and regional health and community services. Adolescents in rural areas require holistic primary care including provision of resources, basic wellbeing needs and advocacy. Programs to support rural adolescents should be integrated across the strengths and opportunities that exist in each unique context.

Evaluating continuity of care incorporating a time protective effect of general practitioner care on diabetes related potentially preventable hospitalisations: An application of threshold effects model

Background Continuity of care with a general practitioner (GP) is vital for management of chronic conditions including diabetes as it provides proactive care facilitating opportunities to prevent or delay progression of disease.&#x0D; Aim To capture the proportion of time people with diabetes are under the protective effect of contact with a GP using the Cover Index and its effect on potentially preventable hospitalisation (PPH) and length of stay (LOS).&#x0D; Methods The linked self-report and administrative health service data of 267,153 participants in the 45 and Up study in New South Wales (NSW) in 2006-2009, obtained from the NSW Centre for Health Record Linkage and the Australian Government Department of Human Services, were used. A cohort of 21,965 people aged 45+ years identified with diabetes before July 2009 and followed up to 2015 were included in the analysis. Time duration protective effect of GP contact was estimated according to severity of diabetes using threshold effect models and then used to calculate the Cover Index. The effect of levels of GP cover on PPH and unplanned PPH and related LOS were estimated using negative binomial models weighted for the inverse probability of treatment to control for observed pre-treatment covariate imbalance.&#x0D; Results Perfect GP cover was observed among 56% of people in the study cohort. Compared with low GP cover, having perfect GP cover was significantly associated with lower PPH (IRR 0.21, 95%CI 0.13-0.35), LOS for PPH (IRR 0.12, 95%CI 0.06-0.24), unplanned PPH (IRR 0.36, 95%CI 0.19-0.68) and LOS for unplanned PPH (IRR 0.39, 95%CI 0.17-0.85) after controlling for the observed pre-treatment covariate imbalance.&#x0D; Conclusion This study suggests that longitudinal continuity of care measured by incorporating a time protective effect of a GP (cover) may be an important factor associated with reduction in PPHs and length of stay independent of other measures of longitudinal continuity.

Association between continuity of provider-adjusted regularity of general practitioner (GP) contact and diabetes-related hospitalisation: A data linkage study combining survey and administrative data

Background and rationale We have previously reported decreased rates and costs of diabetes-related hospitalisations with increasing regularity of general practitioner (GP) contact. However previous work has not adjusted for continuity of provider. Thus, despite the relevance for policy development, whether increased regularity is actually a proxy for, or a consequence of, increasing continuity of provider, or is a discrete facet of continuity of care is unknown.&#x0D; Main Aim To assess the association between continuity of provider-adjusted regularity of GP contact and unplanned diabetes-related hospitalisation or emergency department (ED) presentation.&#x0D; Methods/Approach This retrospective, cross-sectional study used linked administrative (from the Centre for Health Record Linkage &amp; the Department of Human Services) and survey data from the baseline 45 and Up Study (2006-09 n=267,153) with a history of diabetes and at least two GP contacts (n=27,409). Multivariable zero-inflated negative binomial and two part generalised linear models were used to asses unplanned diabetes-related hospitalisations or ED presentations, associated costs and cumulative bed days.&#x0D; Results Highest regularity of GP contact was associated with a lower probability (-0.28) of diabetes-related hospitalisation or ED presentations. For those with a previous hospitalisation or ED presentation, higher regularity was associated with a reduction in the number of hospitalisations or ED presentations (6 to 8%); bed days (30 to 44%); and average cost (23 to 41%). Importantly, continuity of provider did not significantly modify the effect of GP regularity for any outcome.&#x0D; Conclusion Higher regularity of GP contact – that is more evenly dispersed, not necessarily more frequent care – has the potential to reduce health care costs and, for those with a previous hospitalisation, the time spent in hospital, irrespective of continuity of provider. These findings argue for the advocacy of regular care, as distinct from solely continuity of provider, when designing policy and financial incentives for GP-led primary care.

The national economic burden of eating disorders in Wales: a clinical population data study

BackgroundEating disorders have the highest morbidity of all mental disorders in the UK and can require admission to hospital. We aimed to provide whole system quantification of inpatient admission and general practitioner (GP) contact costs to the National Health Service (NHS) for patients with eating disorders in Wales. MethodsThe Secure Anonymised Information Linkage (SAIL) databank contains 84% of all electronic data obtained by NHS Wales General Practices since 1990 and all NHS hospital admissions data for Wales recorded since 1998. We obtained data on hospital admissions between Jan 1, 1998, and June 30, 2017, and GP contacts between July 1, 1990, and June 30, 2017, for patients with eating disorders, diagnosed using International Classification of Diseases (ICD)-9 and ICD-10 codes or GP Read Codes in GP or inpatient records and for a matched control cohort. We calculated total costs of hospital admissions and GP contacts between 1990 and 2017, using published unit costs for these patients, irrespective of year of diagnosis. FindingsBetween July 1, 1990, and June 30, 2017, 15 558 individuals were diagnosed with eating disorders within SAIL. 4707 individuals had complete GP records for the 2 year period before and 3 year period after diagnosis and were matched to four controls each. 4222 individuals within the case cohort had a total of 35 849 admissions with total admission costs of £81 218 113 (£17 254 751 per 1000 individuals) over 20 years between Jan 1, 1998, and June 30, 2017. By contrast, in the control cohort, 13 419 individuals were admitted to hospital with a total cost of £39 305 793 (£2 089 845 per 1000 individuals) for the same 20-year period. The cost of GP contacts over 27 years between July 1, 1990, and June 30, 2017, was £177 406 330 (£37 689 894 per 1000 individuals) for the eating disorder cohort (n=4707) and £321 041 292 (£17 069 401 per 1000 individuals) for patients in the control group (n=18 808). InterpretationEating disorders result in high costs to the NHS, particularly for hospital admissions. Therefore, greater investment in prompt recognition and early intervention for individuals with eating disorders, which greatly shorten duration of illness, are likely to be economically justifiable. FundingHealth and Social Care Wales.

Time to use of primary health care after being informed about increased health risk in HUNT

Abstract Background Seeing a general practitioner (GP) after first discovering conditions related to ill health is important for the prevention or timely treatment of major diseases. Receiving information about increased health risk, e.g. from participating in a health study, might increase awareness and trigger a visit to the GP. The question is: Do people allocated in different socioeconomic (SE) groups respond differently to receiving information about increased health risk? This could indirectly increase socioeconomic inequalities in health. In this study we are aiming to analyse patterns of GP contact after being informed that measurements from the HUNT study had deviant values suggesting increased health risk. Methods We use data from several Norwegian national registries which were linked to the HUNT study (The Nord-Trøndelag Health Study). Cox-proportional hazard models as well as repeated measurement models are estimated in order to explore patterns of GP contact. Health exposures are: measured high blood pressure (BP) (systolic and diastolic), high blood glucose, high serum cholesterol. SE status is measured through educational attainment (low, medium, high). Preliminary results In the analysis for GP contact within a year after HUNT, we had information on 42,581 persons, with 295,188 contacts with primary health service. In our data 8% had clinical measurements indicating high BP (160/100), 60% had high serum cholesterol levels (5,2 mmol/L) and 3% had high blood glucose levels ( &amp;gt; =9 mmol/L). Women in the lowest social group generally used less time to see their GP than both higher educational groups. For men this was less clear cut. Conclusions We aimed to analyse SE differences in response to receiving information about increased health risk. The analysis thus far suggests that women in lower SE groups see their GP a relatively short time after being informed. This is less clear cut for men. Further analysis will shed further light on utilisation patterns. Key messages Women in lower SE groups take less time to see a GP after being informed of increased health risk. SE differences in primary health care utilisation might be less clear cut than previously suggested.

The Multidimensional Prognostic Index in general practice: One-year follow-up study.

Older patients' health problems in general practice (GP) can often not be assigned to a specific disease, requiring a paradigm shift to goal-oriented, personalised care for clinical decision making. To investigate the predictive value of the comprehensive geriatric assessment (CGA)-based Multidimensional Prognostic Index (MPI) in a GP setting with respect to the main healthcare indicators during the 12months following initial evaluation. One hundred twenty-five consecutive patients aged 70years and older were enrolled in a GP and followed up to one year. All patients underwent a CGA based on which the MPI was calculated and subdivided into three risk groups (MPI-1, 0-0.33=low risk, MPI-2, 0.34-0.66=moderate risk and MPI-3, 0.67-1, severe risk). Grade of Care (GC), hospitalization rate, mortality, nursing home admission, use of home care services, falls, number of general practitioner contacts (GPC), of geriatric resources (GR) and geriatric syndromes (GS) during the 12 months following initial evaluation were collected. The MPI was significantly associated with number of GS (P<.001), GR (P<.001), GC (P<.001) as well as with the average number of GPC per year (mean 10.4, P=.046). Interestingly, the clinical judgement of the general practitioner, in this case knowing his patients for 16 years on average, was associated with adverse outcomes to a similar extent than the prediction offered by the MPI (GP/adverse outcomes and MPI/adverse outcomes P < .001). The MPI is strongly associated with adverse outcomes in older GP patients and strongly predicts the number of GPC up to one year after initial evaluation. Considering the feasibility and the strong clinimetric properties of the MPI, its collection should be encouraged as early as possible to disclose risk conditions, implement tailored preventive strategies and improve cost-effectiveness of healthcare resources use.

Contact with primary health care physicians before an acute hospitalisation

Objectives: To assess contacts with general practitioners (GPs), both regular GPs and out-of-hours GP services (OOH) during the year before an emergency hospital admission.Design: Longitudinal design with register-based information on somatic health care contacts and use of municipality health care services.Setting: Four municipalities in central Norway, 2012–2013.Subjects: Inhabitants aged 50 and older admitted to hospital for acute myocardial infarction, hip fracture, stroke, heart failure, or pneumonia.Main outcome measures: GP contact during the year and month before an emergency hospital admission.Results: Among 66,952 identified participants, 720 were admitted to hospital for acute myocardial infarction, 645 for hip fracture, 740 for stroke, 399 for heart failure, and 853 for pneumonia in the two-year study period. The majority of these acutely admitted patients had contact with general practitioners each month before the emergency hospital admission, especially contacts with a regular GP. A general increase in GP contact was observed towards the time of hospital admission, but development differed between the patient groups. Patients admitted with heart failure had the steepest increase of monthly GP contact. A sizable percentage did not contact the regular GP or OOH services the last month before admission, in particular men aged 50–64 admitted with myocardial infarction or stroke.Conclusion: The majority of patients acutely admitted to hospital for different common severe emergency diagnoses have been in contact with GPs during the month and year before the admission. This points towards general practitioners having an important role in these patients’ health care.KEY MESSAGESThere is scarce knowledge about primary health care contact before an emergency hospital admission.The percentage of patients with contacts differed between patient groups, and increased towards hospital admission for most diagnoses, particularly heart failure.More than 50% having monthly general practitioner contact before admission underscores the general practitioners’ role in these patients’ health care.Our results underscore the need to consider medical diagnosis when talking about the role of general practitioners in preventing emergency hospital admissions.

Association between continuity of provider-adjusted regularity of general practitioner contact and unplanned diabetes-related hospitalisation: a data linkage study in New South Wales, Australia, using the 45 and Up Study cohort

ObjectiveTo assess the association between continuity of provider-adjusted regularity of general practitioner (GP) contact and unplanned diabetes-related hospitalisation or emergency department (ED) presentation.DesignCross-sectional study.SettingIndividual-level linked self-report and administrative health service...

Effect of an integrated care pathway on use of primary and secondary healthcare by patients at high risk of emergency inpatient admission: a matched control cohort study in Tower Hamlets

ObjectivesTo assess the effects of an integrated care pathway on the use of primary and secondary healthcare by patients at high risk of emergency inpatient admission.DesignObservational study of a real-life...

Care of general practice patients preceding and following a suicide attempt: observational study in Flemish general practices

ObjectivesFirst, to examine general practitioner (GP) knowledge about the care (needs) of their patients; second, to examine the quality of GP follow-up care; third, to examine the transmission of patient...

Does Use and Timing of Palliative Home Care Have an Effect on Medical Resource Use in the Last Thirty Days Before Death in COPD? A Full-Population Retrospective Study

Background: COPD patients often use extensive medical resources, e.g. frequent hospitalisations, when they are close to death. Palliative home care (PHC) could affect end-of-life medical resource use. However, population studies studying this possible effect for COPD are lacking. Aim: To study the effect of use and timing of PHC on medical resource use in the last 30 days before death (DBD) for COPD. Methods: Retrospective study of all Belgian decedents in 2010-2015 who died with COPD. Odds ratios (OR) for medical resources in the last 30 DBD were calculated between using versus not using PHC, and between four PHC timing categories (>360; 360-181; 180-91; 90-31 DBD) versus not using PHC. Confounders were socio-demographic, care intensity and disease severity variables. Results: Of the 58,527 decedents with COPD, 644 patients (1.1%) received PHC before 30 DBD. Using PHC (versus not using) decreased the OR for hospitalisation (0.35), intensive care unit admission (0.16), specialist contacts (0.58), invasive ventilation (IV) (0.13), medical imaging including chest radiograph (0.34), sedatives (0.48) and hospital death (0.14). It increased the OR for home care (3.27), general practitioner contact (4.65), palliative care unit admission (2.61), non-IV (2.65), gastric tube (2.15), oxygen (2.22), opioids (4.04) and morphine (5.29) (p 360 DBD (p<0.001). Conclusion: PHC use is associated with less extensive medical resource use in the last 30 DBD for COPD. Health policy and services should focus on increasing PHC access, while research should further explore the effects of early initiation of PHC for COPD. Funding: (SBO IWT nr. 140009). Declaration of Interest: The authors declare no conflict of interest. Ethical Approval: The ethics committee of the Ghent University Hospital granted its approval (B670201422382).

Regular General Practitioner contact - analysis of methods for measurement using administrative data

IntroductionThere is a small body of literature examining the relationship between “regularity” of contact with General Practitioners (GPs), i.e. the pattern of visits over time, and health outcomes. Methods previously used to measure regularity may be conflated with the number of GP visits (frequency) which may impact on effect estimates.&#x0D; Objectives and ApproachTwo published regularity measures, one derived from the variance in the days between GP visits and the second a categorical indicator, were assessed alongside a new measure designed to be uncorrelated with frequency. A cohort at risk of diabetes-related hospitalisation was identified from primary care and hospitalisation data. Associations between regularity and frequency were assessed for each measure using negative binomial regression. Hospitalisation outcomes were regressed on regularity scores using negative binomial models, with and without frequency included, to assess whether associations between regularity and frequency biased estimates. Simulated data tested each measure’s responsiveness to changes in GP visit patterns.&#x0D; ResultsThe new regularity measure showed a substantially weaker association between regularity and frequency than the two previously published scores. According to the new measure, more regular GP contact was associated with a reduction in the rate of hospitalisation and this association was unchanged by the inclusion of frequency as a covariate. Under the existing measures regular contact was also associated with reduced hospitalisation, but the association differed depending on whether frequency was included in the model, suggesting that associations between regularity and frequency may confound relationships with health outcomes if uncontrolled for. Simulated data suggested that the measures responded differently to changes in visitation pattern with the existing categorical indicator being the least responsive.&#x0D; Conclusion/ImplicationsDespite a large body of literature on provider continuity, little research has examined regularity of GP contact. This is the first work to compare measures of regularity and represents an important methodological advancement. Researchers should consider regularity of contact as a dimension of continuity of care when designing studies.