Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
Research Area Social Sciences, NORCE Norwegian Research Centre AS, Bergen, Hordaland, Norway.
BMJ Open. 2021 Dec 2;11(12):e051958. doi: 10.1136/bmjopen-2021-051958.
OBJECTIVE: To assess whether continuity of care (COC) with a general practitioner (GP) is associated with mortality and hospital admissions for older patients We argue that the conventional continuity measure may overestimate these associations. To better reflect COC as a GP quality indicator, we present an alternative, service-based measure. DESIGN: Registry-based, population-level longitudinal cohort study. SETTING: Linked data from Norwegian administrative healthcare registries, including 3989 GPs. PARTICIPANTS: 757 873 patients aged 60-90 years with ≥2 contacts with a GP during 2016 and 2017. MAIN OUTCOME MEASURE: All-cause emergency hospital admissions, emergency admissions for ambulatory care sensitive conditions, and mortality, in 2018. RESULTS: We assessed COC using the conventional usual provider of care index (UPC) and an alternative/supplementary index (UPC) based on the COC for all other patients enlisted with the same preferred GP.For both indices, the mean index score was 0.78. Our model controls for demographic and socioeconomic characteristics, prior healthcare use and municipality-fixed effects. Overall, UPC shows a much weaker association between COC and the outcomes. For both indices, there is a negative relationship between COC and hospital admissions. A 0.2-point increase in the index score would reduce admissions for ambulatory care sensitive conditions by 8.1% (CI 7.1% to 9.1%) versus merely 1.9% (0.2% to 3.5%) according to UPC and UPC, respectively. Using UPC, we find that mortality is no longer associated with COC. There was greater evidence for an association between COC and all-cause admissions among patients with low education. CONCLUSIONS: A continuity measure based on each patient's contacts with own preferred GP may overestimate the importance of COC as a feature of the GP practice. An alternative, service-based measure of continuity could be suitable as a quality measure in primary healthcare. Facilitating continuity should be considered a health policy measure to reduce inequalities in health.
目的：评估与全科医生（GP）的连续性护理（COC）是否与老年患者的死亡率和住院有关。我们认为传统的连续性衡量标准可能会高估这些关联。为了更好地将 COC 作为 GP 质量指标来反映，我们提出了一种替代的、基于服务的衡量标准。
设计：基于注册的、人群水平的纵向队列研究。
设置：包括 3989 名全科医生在内的挪威行政医疗保健注册处的相关数据。
参与者：2016 年至 2017 年期间与 GP 至少有 2 次接触的 757873 名年龄在 60-90 岁的患者。
主要结果测量：2018 年全因急诊住院、门诊护理敏感条件的急诊住院和死亡率。
结果：我们使用传统的常用提供者护理指数（UPC）和基于所有其他患者与相同首选 GP 登记的 COC 的替代/补充指数（UPC）来评估 COC。对于这两个指数，平均指数得分为 0.78。我们的模型控制了人口统计学和社会经济特征、先前的医疗保健使用和市固定效应。总体而言，UPC 显示 COC 与结果之间的关联要弱得多。对于这两个指数，COC 与住院治疗之间呈负相关。指数得分提高 0.2 分，门诊护理敏感条件的住院率将降低 8.1%（7.1%至 9.1%），而根据 UPC 和 UPC，这一比例仅为 1.9%（0.2%至 3.5%）。使用 UPC，我们发现死亡率与 COC 不再相关。在受教育程度较低的患者中，COC 与全因入院之间的关联证据更多。
结论：基于每个患者与自己首选 GP 的接触情况的连续性衡量标准可能会高估 COC 作为 GP 实践特征的重要性。连续性的替代、基于服务的衡量标准可能适合作为初级保健质量衡量标准。促进连续性应被视为减少健康不平等的一项卫生政策措施。
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