Continuity of care in general practice and patient outcomes in Denmark: a population-based cohort study

Abstract

Background Continuity of care in general practice has been associated with improved patient outcomes, but the influence of being listed with the same clinic over time has not been thoroughly studied on a national level. We aimed to evaluate whether clinic continuity in general practice was associated with patient outcomes in Denmark. Methods We conducted a population-based cohort study using data from multiple Danish national registers from Jan 1, 2006, to Dec 31, 2021, including all citizens aged 18 years or older who were listed with a general practice clinic on Jan 1, 2022. During 12-month follow-up from Jan 1, 2022, until Dec 31, 2022 (ie, end of study), emigration, or death, whichever came first, we examined the association of duration of current clinic listing and number of previous clinic changes with risk of all-cause mortality via a Cox regression model, with low cross-sectoral continuity of care via a logistic regression model, and with unplanned hospital contacts and out-of-hours contacts via negative binomial regression models. These models were adjusted for demographic characteristics, socioeconomic factors, and comorbidities. Findings The study population comprised 4 530 293 adults (2 305 856 [50·9%] female, 2 224 437 [49·1%] male; 546 753 [12·1%] immigrants or descendants of immigrants). In fully adjusted models, shorter clinic listing duration was associated with worse patient outcomes. Compared with a patient listed with the same general practice clinic for 10 years or longer, a patient listed for 0–1 years had a higher risk of all-cause mortality (hazard ratio 1·21, 95% CI 1·17–1·25), lower degree of cross-sectoral continuity of care (odds ratio 1·20, 95% CI 1·13–1·27), more unplanned hospital contacts (incidence rate ratio 1·25, 95% CI 1·21–1·30), and more out-of-hours contacts (1·21, 1·17–1·26). More previous clinic changes were also associated with increased risk of these four outcomes. Some associations between frequent clinic changes and health outcomes were mitigated by long-term listing with the current clinic. Interpretation Our study suggests that longitudinal continuity at the clinic level in general practice can potentially reduce adverse patient outcomes and improve continuity across health-care sectors. Our findings support initiatives to sustain continuity in general practice and raise the question of whether clinic switching should prompt increased clinical attention. Funding The General Practice Research Foundation of the Central Denmark Region and the Danish Foundation for General Practice.

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