Kristin Hestmann Vinjerui, Andreas Asheim, Kjartan Sarheim Anthun, Fredrik Carlsen, Bente Prytz Mjølstad, Sara Marie Nilsen, Kristine Pape, Johan Håkon Bjørngaard
{"title":"全科医生退休或搬迁及其与医疗服务使用和死亡率的关系:一项利用挪威全国数据进行的队列研究。","authors":"Kristin Hestmann Vinjerui, Andreas Asheim, Kjartan Sarheim Anthun, Fredrik Carlsen, Bente Prytz Mjølstad, Sara Marie Nilsen, Kristine Pape, Johan Håkon Bjørngaard","doi":"10.1136/bmjqs-2023-017064","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Aim: </strong>To investigate changes in the Norwegian population's overall healthcare use and mortality after discontinuity due to Regular GPs retiring or relocating.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>Regular GPs retirement and relocation were associated with small to moderate increases in healthcare use among listed patients, while mortality was unaffected.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":5.6000,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"General practitioners retiring or relocating and its association with healthcare use and mortality: a cohort study using Norwegian national data.\",\"authors\":\"Kristin Hestmann Vinjerui, Andreas Asheim, Kjartan Sarheim Anthun, Fredrik Carlsen, Bente Prytz Mjølstad, Sara Marie Nilsen, Kristine Pape, Johan Håkon Bjørngaard\",\"doi\":\"10.1136/bmjqs-2023-017064\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Aim: </strong>To investigate changes in the Norwegian population's overall healthcare use and mortality after discontinuity due to Regular GPs retiring or relocating.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>Regular GPs retirement and relocation were associated with small to moderate increases in healthcare use among listed patients, while mortality was unaffected.</p>\",\"PeriodicalId\":9077,\"journal\":{\"name\":\"BMJ Quality & Safety\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":5.6000,\"publicationDate\":\"2024-07-26\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"BMJ Quality & Safety\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1136/bmjqs-2023-017064\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"HEALTH CARE SCIENCES & SERVICES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMJ Quality & Safety","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/bmjqs-2023-017064","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
引用次数: 0
摘要
背景:全科医生与患者关系的连续性与更好的医疗保健结果有关。然而,很少有研究调查了全科医生退休或搬迁时,永久性中断对所有挂号病人的影响。目的:调查挪威人口在正规全科医生退休或搬迁导致医疗服务中断后,总体医疗服务使用情况和死亡率的变化:我们将全国登记册联系起来,比较了退休或搬迁的正规全科医生与继续工作的正规全科医生的匹配个人的医疗服务使用天数和死亡率。我们纳入了接触前 3 年的名单患者,并在接触后对他们进行了长达 5 年的跟踪调查。我们采用泊松回归的差分设计来评估随时间的变化:从 2011 年到 2020 年,我们发现有 819 名正规全科医生退休,228 名全科医生搬迁,共隶属于 1 165 295 人。与中断前 3 年相比,在中断后的第 1 年,白天接触全科医生的比率比(RR)增加了 3%(95% CI 2 至 4),相当于每 1000 名患者增加了 148 次(95% CI 54 至 243 次)接触。这一增长持续了 5 年。全科医生非工作时间的接触次数在第一年有所增加,RR 为 1.04(95% CI 0.99 至 1.09),相当于每 1000 名患者中有 16 次(95% CI -5 至 37 次)接触。计划内的医院接触在第一年增加了 3%(95% CI 2 到 4),并持续到第五年。急性期医院接触增加了 5%(95% CI 3 到 7),主要集中在第一年。这些 1 年的影响相当于每 1000 名患者中有 51 次(95% CI 18 至 83 次)计划住院接触和 13 次(95% CI 7 至 18 次)急性住院接触。结论:定期全科医生退休和搬迁对死亡率的影响并不明显:结论:全科医生退休和搬迁与列名患者医疗服务使用量的小幅至中幅增加有关,而死亡率未受影响。
General practitioners retiring or relocating and its association with healthcare use and mortality: a cohort study using Norwegian national data.
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.
期刊介绍:
BMJ Quality & Safety (previously Quality & Safety in Health Care) is an international peer review publication providing research, opinions, debates and reviews for academics, clinicians and healthcare managers focused on the quality and safety of health care and the science of improvement.
The journal receives approximately 1000 manuscripts a year and has an acceptance rate for original research of 12%. Time from submission to first decision averages 22 days and accepted articles are typically published online within 20 days. Its current impact factor is 3.281.