Article Text
Abstract
Background Continuity in the general practitioner (GP)-patient relationship is associated with better healthcare outcomes. However, few studies have examined the impact of permanent discontinuities on all listed patients when a GP retires or relocates.
Aim To investigate changes in the Norwegian population’s overall healthcare use and mortality after discontinuity due to Regular GPs retiring or relocating.
Methods Linking national registers, we compared days with healthcare use and mortality for matched individuals affiliated with Regular GPs who retired or relocated versus continued. We included list patients 3 years prior to exposure and followed them up to 5 years after. We assessed changes over time employing a difference-in-differences design with Poisson regression.
Results From 2011 to 2020, we identified 819 Regular GPs retiring and 228 moving, affiliated with 1 165 295 people. Relative to 3 years before discontinuity, the rate ratio (RR) of daytime GP contacts, increased 3% (95% CI 2 to 4) in year 1 after discontinuity, corresponding to 148 (95% CI 54 to 243) additional contacts per 1000 patients. This increase persisted for 5 years. Out-of-hours GP contacts increased the first year, RR 1.04 (95% CI 0.99 to 1.09), corresponding to 16 (95% CI −5 to 37) contacts per 1000 patients. Planned hospital contacts increased 3% (95% CI 2 to 4) in year 1, persisting into year 5. Acute hospital contacts increased 5% (95% CI 3 to 7), primarily in the first year. These 1-year effects corresponded to 51 (95% CI 18 to 83) planned and 13 (95% CI 7 to 18) acute hospital contacts per 1000 patients. Mortality was unchanged up to 5 years after discontinuity.
Conclusion Regular GPs retirement and relocation were associated with small to moderate increases in healthcare use among listed patients, while mortality was unaffected.
- general practice
- health services research
- transitions in care
Data availability statement
Data may be obtained from a third party and are not publicly available.
Statistics from Altmetric.com
Data availability statement
Data may be obtained from a third party and are not publicly available.
Footnotes
X @jhbjorngaard
Contributors KHV and AA share joint first authorship. KHV, AA, KSA, FC, BPM, SMN, KP and JHB contributed to conceptualisation and developing the study design. AA and KSA performed data curation and AA formal analysis and data visualisation. KHV prepared the original draft, while AA, KSA, FC, BPM, SMN, KP and JHB contributed substantially to internal review and editing to both first submission and review. JHB is the project administrator and supervisor, and is also responsible for the overall content of the work (guarantor).
Funding This study was funded by Norges Forskningsråd (295989, 344375).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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