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Cited by 333Primary Care and Health OutcomesHospital Admissions and OutcomesChronic Disease Management Strategies

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

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Sandvik, Hogne, Hetlevik, Øystein, Blinkenberg, Jesper, Hunskaar, Steinar·2022·British Journal of General Practice
DOI 10.3399/bjgp.2021.0340PMC PMC8510690
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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.

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  • Increased continuity of care, particularly with a family physician, is associated with decreased hospitalizations, fewer emergency visits, more preventive care, improved patient satisfaction, safer prescribing, lower rates of major adverse events and reduced mortality.

    “In addition, increased continuity of care, particularly with a family physician, is associated with decreased hospitalizations, fewer emergency visits, more preventive care, improved patient satisfaction, safer prescribing, lower rates of major adverse events and reduced mortality [11–17].”

    From Improved access to and continuity of primary care after attachment to a family physician: longitudinal cohort study on centralized waiting lists for unattached patients in Quebec, Canada (2022) · cites this paper as [17]

    The Discussion’s Summary reports that longer continuity with a regular GP is associated with fewer acute hospital admissions, less out-of-hours care, and lower mortality. The Introduction and Discussion also report associations with less emergency-department use and greater patient satisfaction. Our copy does not support the sentence’s additional claims about more preventive care, safer prescribing, or fewer major adverse events; no page numbers are available in the indexed passages. (LLM, conf=0.88)

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Authors
Sandvik, H., Hetlevik, Ø., Blinkenberg, J., & Hunskaar, S.
Affiliations
  • NORCE Research AS (NO)
  • University of Bergen (NO)
Venue
British Journal of General Practice
Publisher
Royal College of General Practitioners
Published
2021-08-26
Volume
72
Issue
715
Pages
e84-e90
ISSN
  • 0960-1643 (ISSN-L)
  • 1478-5242
DOI
10.3399/bjgp.2021.0340
PMC
PMC8510690
OpenAlex
W3195296969
Cited by
333
References
32
Citations by year
2026: 61 · 2025: 65 · 2024: 83 · 2023: 74 · 2022: 46 · 2021: 4
FWCI
58.13
Type
journal article
Language
en
Open access
Licence
Locations
  • British Journal of General Practice (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
  • Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
  • Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
Keywords
continuity of care, general practitioner-patient relationship, relationship duration, out-of-hours care, acute hospitalization, mortality, primary care quality, dose-response relationship, general practice
MeSH terms
Hospitalization, Humans, Norway, Registries, After-Hours Care, General Practice

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