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Health services research
Research
Associations between primary healthcare and unplanned medical admissions in Norway: a multilevel analysis of the entire elderly population
  1. Trygve S Deraas1,
  2. Gro R Berntsen2,
  3. Andy P Jones3,
  4. Olav H Førde4,
  5. Erik R Sund5
  1. 1Center of Clinical Documentation and Evaluation, Northern Norway Regional Health Authority, Box 6, N-9038 Tromsø, Norway
  2. 2Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway
  3. 3Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, UK
  4. 4Department of Community Medicine, University of Tromsø, Tromsø, Norway
  5. 5Department of Public Health and General Practice, Faculty of Medicine, HUNT Research Centre, Norwegian University of Science and Technology, Levanger, (NTNU), Norway
  1. Correspondence to Dr Trygve S Deraas; trygve.deraas{at}uit.no

Abstract

Objective To examine if individual risk of unplanned medical admissions (UMAs) was associated with municipality general practitioner (GP) or long-term care (LTC) volume among the entire Norwegian elderly population.

Design Cross-sectional population-based study.

Setting 428 of 430 Norwegian municipalities in 2009.

Participants All Norwegians aged ≥65 years (n=721 915; 56% women—15% of the total population).

Main outcome measure Individual risk of UMA.

Results Using a multilevel analytical framework, consisting of individuals (N=722 464) nested within municipalities (N=428), nested within local hospital areas (N=52) we found no association between municipality GP or LTC volume and UMAs. However, we found that higher LTC levels of provision were associated with fewer hospitalisations among the older age groups. A modest geographical variability was observed for UMA in adjusted analysis.

Conclusions A higher primary healthcare volume was only associated with fewer UMAs among the oldest old in a universally accessible healthcare system.

  • Primary Care
  • Long-term Care
  • Unplanned Admissions
  • Small Area Analyses

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/

https://doi.org/10.1136/bmjopen-2013-004293

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