Øystein Hetlevik1, Sturla Gjesdal. 1. Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway. oystein.hetlevik@isf.uib.no
Abstract
OBJECTIVE: Personal continuity is regarded as a core value in general practice. The aim of this study was to determine the level of personal continuity in Norwegian general practice. An investigation was made of the associations between high levels of personal continuity and patient, general practitioner (GP), and list characteristics. DESIGN: Cross-sectional register-based study. SETTING: Norwegian general practice in 2009. SUBJECTS: 3220 GPs and 3 725 998 patients on the GP lists. MAIN OUTCOME MEASURES: The Usual Provider Continuity Index (UPC), which measures the proportion of consultations made by the usual GP, was estimated for patients and aggregated to the GP list level. GPs were grouped into quartiles based on the UPC. Being a GP with a UPC in the two highest quartiles (UPC ≥ 0.80) was the outcome in the statistical analyses. STATISTICS: Poisson regression models were used to estimate relative risks (RR). RESULTS: The overall UPC was 0.78, increasing gradually from 0.68 in patients < 15 years of age to 0.86 for patients ≥ 60 years of age, and from 0.75 to 0.83 for patients with < 3 annual consultations compared with patients with > 10 consultations. A UPC > 0.80 was associated with longer patient lists and high GP consultation rates. Working in municipalities with < 10 000 residents was negatively associated with a high UPC. The UPC level for GPs was associated with total utilization of GP consultations in the list populations. CONCLUSION: Overall, the Norwegian goal of a personal GP has been achieved; however, there are substantial variations between GPs and lower UPCs among young patients and in smaller municipalities.
OBJECTIVE: Personal continuity is regarded as a core value in general practice. The aim of this study was to determine the level of personal continuity in Norwegian general practice. An investigation was made of the associations between high levels of personal continuity and patient, general practitioner (GP), and list characteristics. DESIGN: Cross-sectional register-based study. SETTING: Norwegian general practice in 2009. SUBJECTS: 3220 GPs and 3 725 998 patients on the GP lists. MAIN OUTCOME MEASURES: The Usual Provider Continuity Index (UPC), which measures the proportion of consultations made by the usual GP, was estimated for patients and aggregated to the GP list level. GPs were grouped into quartiles based on the UPC. Being a GP with a UPC in the two highest quartiles (UPC ≥ 0.80) was the outcome in the statistical analyses. STATISTICS: Poisson regression models were used to estimate relative risks (RR). RESULTS: The overall UPC was 0.78, increasing gradually from 0.68 in patients < 15 years of age to 0.86 for patients ≥ 60 years of age, and from 0.75 to 0.83 for patients with < 3 annual consultations compared with patients with > 10 consultations. A UPC > 0.80 was associated with longer patient lists and high GP consultation rates. Working in municipalities with < 10 000 residents was negatively associated with a high UPC. The UPC level for GPs was associated with total utilization of GP consultations in the list populations. CONCLUSION: Overall, the Norwegian goal of a personal GP has been achieved; however, there are substantial variations between GPs and lower UPCs among young patients and in smaller municipalities.
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