Center of Clinical Documentation and Evaluation, Northern Norway Regional Health Authority, Tromsø, Norway.
BMJ Open. 2013 Jan 11;3(1):e002041. doi: 10.1136/bmjopen-2012-002041.
To examine if increased general practice activity is associated with lower outpatient specialist clinic use.
Cross-sectional population based study.
All 430 Norwegian municipalities in 2009.
All Norwegians aged ≥65 years (n=721 915; 56% women-15% of the total population).
Specialised care outpatient clinic consultations per 1000 inhabitants (OPC rate). Main explanatory: general practitioner (GP) consultations per 1000 inhabitants (GP rate).
In total, there were 3 339 031 GP consultations (57% women) and 1 757 864 OPC consultations (53% women). The national mean GP rate was 4625.2 GP consultations per 1000 inhabitants (SD 1234.3) and the national mean OPC rate was 2434.3 per 1000 inhabitants (SD 695.3). Crude analysis showed a statistically significant positive association between GP rates and OPC rates. In regression analyses, we identified three effect modifiers; age, mortality and the municipal composite variable of 'hospital status' (present/not present) and 'population size' (small, medium and large). We stratified manually by these effect modifiers into five strata. Crude stratified analyses showed a statistically significant positive association for three out of five strata. For the same three strata, those in the highest GP consultation rate quintile had higher mean OPC rates compared with those in the lowest quintile after adjustment for confounders (p<0.001). People aged ≥85 in small municipalities had approximately 30% lower specialist care use compared with their peers in larger municipalities, although the association between GP-rates and OPC-rates was still positive.
In a universal health insurance system with high GP-accessibility, a health policy focusing solely on a higher activity in terms of GP consultations will not likely decrease OPC use among elderly.
研究基层医疗活动增加是否与减少专科门诊就诊相关。
基于人群的横断面研究。
2009 年挪威所有 430 个市。
所有年龄≥65 岁的挪威人（n=721915；女性占 56%，占总人口的 15%）。
每 1000 居民的专科门诊就诊率（门诊就诊率）。主要解释变量：每 1000 居民的全科医生就诊率（GP 就诊率）。
共有 3339031 次全科医生就诊（57%为女性）和 1757864 次专科门诊就诊（53%为女性）。全国平均 GP 就诊率为 4625.2 次/1000 居民（SD 1234.3），全国平均 OPC 就诊率为 2434.3 次/1000 居民（SD 695.3）。初步分析显示 GP 就诊率与 OPC 就诊率之间存在统计学显著正相关。在回归分析中，我们确定了三个效应修饰因子；年龄、死亡率和市复合变量“医院状况”（存在/不存在）和“人口规模”（小、中、大）。我们手动按这些效应修饰因子分为五组。分层分析显示，五组中有三组存在统计学显著的正相关。对于相同的三组，在调整混杂因素后，GP 就诊率最高五分位组的 OPC 就诊率均高于最低五分位组（p<0.001）。在小市中年龄≥85 岁的人比大市中年龄相仿的人接受专科治疗的比例约低 30%，尽管 GP 就诊率和 OPC 就诊率之间的关联仍然是正向的。
在具有高 GP 可及性的全民医疗保险体系中，单纯关注 GP 就诊量增加的卫生政策不太可能降低老年患者的 OPC 使用。
