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

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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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Figure 1. Associations between continuity measured as years with the same RGP and odds for use of OOH services, acute hospital admissions, and mortality during 2018. OOH = out-of-hours. OR = odds ratio.
Figure 1. Associations between continuity measured as years with the same RGP and odds for use of OOH services, acute hospital admissions, and mortality during 2018. OOH = out-of-hours. OR = odds ratio.CC BY · PubMed Central

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Metadata

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 › Medicine › Family Practice › Primary Care and Health Outcomes
  • Health Sciences › Nursing › Leadership and Management › 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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