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Norway: Continuity care in General Practice

Continuity is a core value of primary care. McWhinney described continuity as an implicit contract between a patient and a GP, who then takes personal responsibility for the patient’s medical needs.¹^,² Continuity is not limited by the type of disease and bridges episodes of various illnesses. Greater continuity with a primary care physician has been shown to be associated with lower mortality rates,³ fewer hospital admissions,⁴^,⁵ less use of emergency departments,⁶ and fewer referrals for specialist health care.⁷^,⁸ Nevertheless, continuity has been declining in recent years.⁹

There is no uniform agreement about how continuity should be defined, but three aspects are usually described: informational, longitudinal, and interpersonal.¹⁰ Informational continuity means that the doctor has adequate access to all relevant information about the patient. Longitudinal continuity means that it transcends multiple episodes of illness, and interpersonal refers to a trustful relationship between patient and physician. Various methods have been used for measuring continuity. Most of them are based on visit patterns with different providers over time.¹⁰^,¹¹ An example is the Usual Provider of Care (UPC) index, which calculates the percentage of all contacts that is with the most frequent provider.¹² Most of these studies have been conducted with limited patient samples and rather short observation periods. There is scarce literature on studies with large- or full-scale populations, long follow-up, and hard endpoints.

In a limited number of countries, such as the UK, the Netherlands, Denmark, or Norway, most inhabitants are listed with a general practice or a named regular general practitioner (RGP) who is responsible for taking care of their medical needs. Such RGP schemes are usually established not only to increase continuity of care as an assumed aspect of quality, but also to prevent unnecessary spending by introducing the RGP as a gatekeeper. It should be noted, however, that patients also value such personal relationships with their RGP.¹³

The aim of the present study, based on Norwegian registry data, was to analyse, on a national level, the effects of longitudinal RGP continuity associated with use of out-of-hours (OOH) services, acute hospital admissions, and mortality.

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