Ph.d. avhandlinger finansiert av AMFF 2008 -

Listen og legen - en studie av ulikhet i fastlegeordningen

Listen og legen - en studie av ulikhet i fastlegeordningenRegister-based studies on continuity, collaboration and equity in general practiceØystein HetlevikUniversitetet i BergenDisputas 11.4.13
11. april 2013

Universitetets opplysninger
https://bora.uib.no/handle/1956/6556

Abstract
 
Background: Continuity of care, collaboration regarding patients and equity in service delivery are core values and quality elements in general practice.

Aim: To assess how these core values are reflected in the practice of Norwegian general practitioners (GPs) and to explore the impact of GP-, list- and population characteristics on the variation in practice concerning these core values.

Method: Cross-sectional nationwide register based studies of GPs, GPs’ lists and GPs’ practice activities from different years in the period 2002–2009.

Results: 78% of consultations in the list patients system were with the regular GP when this GP were in regular practice during a year. Personal continuity was highest for patient > 60 years, patients using GP most frequently and by GPs with larger list size. However, in a one fourth of lists > 32% of all consultations were with another GP. On average, GPs participated in 30 patient centred multidisciplinary meetings in one year and 54% of meetings concerned mental problems. Rates of participation varied considerably among GPs. GP age < 45 years, shorter list size, higher proportion of disadvantaged patients and smaller municipality were factors associated with higher rates of meetings. When grouping GP lists in quintiles according to socioeconomic status of list populations, a 13% increase in consultation rates and 26% increase in total fee-for-service per patients were observed comparing highest to lowest level, adjusted for other GP- and list factors. Frequency of consultations > 60 years, patients using GP most frequently and by GPs with larger list size. However, in a one fourth of lists > 32% of all consultations were with another GP. On average, GPs participated in 30 patient centred multidisciplinary meetings in one year and 54% of meetings concerned mental problems. Rates of participation varied considerably among GPs. GP age < 45 years, shorter list size, higher proportion of disadvantaged patients and smaller municipality were factors associated with higher rates of meetings. When grouping GP lists in quintiles according to socioeconomic status of list populations, a 13% increase in consultation rates and 26% increase in total fee-for-service per patients were observed comparing highest to lowest level, adjusted for other GP- and list factors. Frequency of consultations > 32% of all consultations were with another GP. On average, GPs participated in 30 patient centred multidisciplinary meetings in one year and 54% of meetings concerned mental problems. Rates of participation varied considerably among GPs. GP age < 45 years, shorter list size, higher proportion of disadvantaged patients and smaller municipality were factors associated with higher rates of meetings. When grouping GP lists in quintiles according to socioeconomic status of list populations, a 13% increase in consultation rates and 26% increase in total fee-for-service per patients were observed comparing highest to lowest level, adjusted for other GP- and list factors. Frequency of consultations > 20 minutes and use of medical procedures in consultations did not differ. The higher workload for GPs with more disadvantaged list populations was associated with shorter lists. Young people had low consultation rates. Markers of high workload by GPs were associated with lower rates of consultations with young people. Conclusion: Overall, the core values continuity, collaboration and equity are clearly reflected in Norwegian general practice, but with considerable variations between GPs. Improvements and more uniform practice are needed, especially regarding collaboration in teams and in GP services for young people.

Articles
Paper I: Hetlevik, O. & Gjesdal, S. (2012) Personal continuity of care in Norwegian general practice: A national cross-sectional study. Scandinavian Journal of Primary Health Care 30(4): 214-221, December 2012 . Full text not available in BORA due to publisher restrictions. The article is available at:http://dx.doi.org/10.3109/02813432.2012.735554 

Paper II: Hetlevik, O. & Gjesdal, S. (2010) Norwegian GPs' participation in multidisciplinary meetings: A register-based study from 2007. BMC Health Service Research 2010(10) :309, November 2010. The article is available at:http://hdl.handle.net/1956/4640 

Paper III: Hetlevik, O. & Gjesdal, S. (2012) Does socioeconomic status of list populations affect GP practice? A register-based study of 2201 Norwegian GPs. European Journal of General Practice. 18(4): 212-218, December 2012. Full text not available in BORA due to publisher restrictions. The article is available at:http://dx.doi.org/10.3109/13814788.2012.702208 

Paper IV: Hetlevik, Ø., Haug, K. & Gjesdal, S. (2010) Young people and their GP: a register-based study of 1717 Norwegian GPs. Family Practice 27(1): 3-8, February 2010. Full text not available in BORA due to publisher restrictions. The article is available at: http://dx.doi.org/10.1093/fampra/cmp073