Article Text

Original research
How does general practitioner discontinuity affect healthcare utilisation? An observational cohort study of 2.4 million Norwegians 2007–2017
  1. Lena Janita Skarshaug1,
  2. Silje Lill Kaspersen1,2,
  3. Johan Håkon Bjørngaard1,3,
  4. Kristine Pape1
  1. 1Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
  2. 2Digital, SINTEF, Trondheim, Norway
  3. 3Faculty of Nursing and Health Sciences, Nord Universitet - Levanger Campus, Levanger, Norway
  1. Correspondence to MD PhD Lena Janita Skarshaug; lena.j.skarshaug{at}


Objectives Patients may benefit from continuity of care by a personal physician general practitioner (GP), but there are few studies on consequences of a break in continuity of GP. Investigate how a sudden discontinuity of GP care affects their list patients’ regular GP consultations, out-of-hours consultations and acute hospital admissions, including admissions for ambulatory care sensitive conditions (ACSC).

Design Cohort study linking person-level national register data on use of health services and GP affiliation with data on GP activity and GP characteristics.

Setting Primary care.

Participants 2 409 409 Norwegians assigned to the patient lists of 2560 regular GPs who, after 12 months of stable practice, had a sudden discontinuity of practice lasting two or more months between 2007 and 2017.

Primary and secondary outcome measures Monthly GP consultations, out-of-hours consultations, acute hospital admissions and ACSC admissions in periods during and 12 months after the discontinuity, compared with the 12-month period before the discontinuity using logistic regression models.

Results All patient age groups had a 3%–5% decreased odds of monthly regular GP consultations during the discontinuity. Odds of monthly out-of-hours consultations increased 2%–6% during the discontinuity for all adult age groups. A 7%–9% increase in odds of ACSC admissions during the period 1–6 months after discontinuity was indicated in patients over the age of 65, but in general little or no change in acute hospital admissions was observed during or after the period of discontinuity.

Conclusions Modest changes in health service use were observed during and after a sudden discontinuity in practice among patients with a previously stable regular GP. Older patients seem sensitive to increased acute hospital admissions in the absence of their personal GP.

  • primary care
  • epidemiology
  • public health
  • health & safety

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  • Contributors KP, JHB, LJS and SLK conceived the study and its design. KP and JHB contributed to design of the study protocol and facilitated acquisition of all data. KP and LJS prepared and analysed the data. JHB and SLK provided input on the discussion and interpretation of the findings. LJS drafted the first version of the manuscript. All authors contributed to and approved the final manuscript. All the authors have read the final version of the manuscript and agreed to its submission.

  • Funding This work was supported by the Norwegian University of Science and Technology and is a part of a larger project 'Healthcare services under pressure—Consequences for patient flows, efficiency and patient safety in Norway' funded by the Norwegian Research Council (grant number 256579). JHB was funded by the Norwegian Research Council (grant number 295989).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The Regional Committee for Medical and Health Research Ethics in Central Norway approved the study (2011/2047).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. The data used in this study are publicly available, given approval.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.