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Continuity in general practice as predictor of mortality, acute hospitalisation, and use of out-of-hours care..., 2021, Sandvik, Hetlevik, et al

Discussion in 'Other health news and research' started by JohnTheJack, Oct 5, 2021.

  1. JohnTheJack

    JohnTheJack Moderator Staff Member

    Messages:
    4,124
    Full title:
    Continuity in general practice as predictor of mortality, acute hospitalisation, and use of out-of-hours care: a registry-based observational study in Norway

    https://bjgp.org/content/early/2021/10/04/BJGP.2021.0340

     
  2. Hutan

    Hutan Moderator Staff Member

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    Location:
    Aotearoa New Zealand
    I haven't read the paper, but surely assuming a long association with one GP as being causal for lower mortality and the rest is way too simplistic?

    Thinking about what might cause someone to not have a long association -
    * housing insecurity - people who own their own home will tend to have more stability in their address - and be better off financially. And so be able to afford better food; find it easier to participate in national health screening programmes because the letters and emails find them; live in houses that are healthier; live in neighbourhoods that are healthier.
    * mental illness and substance abuse - tied up with poverty, but also the capacity to make choices that will help physical health
    * dissatisfaction with their GPs - People with health conditions that aren't easily managed or are often stigmatised are more likely to be dissatisfied and are more likely to change doctors. Even just someone with a standard health condition is a lot more likely to be dissatisfied with their GP, or move to a different GP in order to get better care, than someone who is healthy and hardly ever goes to their GP.
    * rural addresses. People in rural areas may not have much choice in GP, and so may stick with the one they can get to. Their lower use of out of hours care and hospital admissions could well be related to the difficulty in accessing those services, and some choice around that for minor health issues.
     
    Michelle, Milo, JohnTheJack and 5 others like this.
  3. Hutan

    Hutan Moderator Staff Member

    Messages:
    21,002
    Location:
    Aotearoa New Zealand
    Now I've read the paper. I do think continuity of care is a good thing, so I can understand why the researchers might want to produce some evidence in support of that.

    And there were some adjustments - for the patient's level of education, for their level of health (but not mental health) and 'centrality' (rural/urban), although little detail is given about the adjustments.

    But, there was little acknowledgement that factors like personal income and mental health affect both 'continuity of care' and 'hospital use' rather than 'continuity of care' being a key driver of health outcomes.

    The paper would have been a lot more persuasive if they had stratified the very large database into people with different characteristics, and shown how continuity of care might help people in each of those groups.
     
    Michelle, JohnTheJack, Sean and 3 others like this.
  4. JohnTheJack

    JohnTheJack Moderator Staff Member

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    4,124
    Thanks for your analysis, @Hutan Yes, I agree that there are confounding factors. Though I am a supporter of continuity of care. Like you I think it is a good thing.
     
    Peter Trewhitt, Milo and Hutan like this.
  5. Peter Trewhitt

    Peter Trewhitt Senior Member (Voting Rights)

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    Subjectively seeing the same trusted health professionals over time is much more preferable than an ever changing sequence of strangers, however though I see continuity of ‘good’ care as desirable, continuity of ‘bad’ care can be disastrous.
     
    Hutan, Frankie and Trish like this.
  6. Midnattsol

    Midnattsol Moderator Staff Member

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    2,482
    For context, there is a large debate in Norway on how our GP system should be, as the current system is somewhat falling apart (GPs quitting, few med students wants to become GPs, many people are without a GP in their area).
     
    Michelle, Hutan, Trish and 1 other person like this.

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