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

Abstract

Background Continuity, usually considered a quality aspect of primary care, is under pressure. Aim To analyse the association between longitudinal continuity with a named regular general practitioner (RGP) and use of out-of-hours (OOH) services, acute hospitalization, 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 hospitalization, 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 categorized as 1, 2–3, 4–5, 6–10, 11–15, and > 15 years. Results are given as adjusted odds ratio (OR) with 95 % confidence interval resulting from multilevel logistic regression analyses. Results Compared with a one-year RGP-patient relationship the OR for use of OOH services decreased gradually from 0.87 (0.86 – 0.88) after 2 – 3 years duration to 0.70 (0.69 – 0.71) after more than 15 years. OR for acute hospitalization decreased gradually from 0.88 (0.86 – 0.90) after 2 – 3 years duration to 0.72 (0.70 – 0.73) after more than 15 years. OR for dying decreased gradually from 0.92 (0.86 – 0.98) after 2 – 3 years duration to 0.75 (0.70 – 0.80) after an RGP-patient relationship of more than 15 years. Conclusion Length of RGP-patient relationship is significantly associated with lower use of out-of-hours services, fewer acute hospitalizations, and lower mortality. The associations are dose-dependent and probably causative.