BackgroundContinuity of GP care is associated with reduced hospitalisations, but solid documentation of its relationship to use of outpatient specialist services is lacking.

BackgroundHealth reforms in many countries affect the scope and nature of primary care. General Practitioners (GPs) are expected to spend more time developing public health, preventive health care, coordination of care and teamwork. We aimed to explore which professional activities GPs consider to be meaningful and how they would like to prioritise tasks.MethodsIn a cross sectional online survey 3,270 GPs were invited to consider twenty different activities in general practice. They were asked to rate each of them on a Likert scale anchored from 1 (not meaningful) to 5 (very meaningful). They then selected three activities from the item list on which they would like to spend more time and three activities on which they would like to spend less time. We used multinomial logistic regression to explore associations between the GPs’ preferences for time spent on preventive health care activities and age, gender and practice characteristics.ResultsApproximately 40% (n=1,308) responded. The most meaningful activities were handling common symptoms and complaints (94% scored 4 or 5), chronic somatic diseases (93%), terminal care (80%), chronic psychiatric diseases (77%), risk conditions (76%) and on call emergency services (70%). In terms of priority the same items prevailed except that GPs would like to spend less time on emergency services. Items with low priority were health certificates, practice administration, meetings with local health authorities, medically unexplained symptoms, addiction medicine, follow up of people certified unfit for work, psychosocial problems, preventive health clinics for children and school health services. In multivariate regression models physician and practice characteristics explained no more than 10% of the variability in the GPs’ preferences for time spent on preventive health care services.ConclusionsThe GPs found diagnosis and treatment of diseases most meaningful. Their priorities were partly at odds with those of the health authorities and policy makers.

The GPHs have a pre-hospital "buffer" function by preventing patients with acute symptoms from being unnecessarily admitted to general hospitals through short-term observation stays. A post-hospital function was also demonstrated, since GPHs allow for long-term follow up stays for patients transferred from general hospitals.

The majority of Norwegian GPs had and preferred private practice, but a significant minority would prefer a salaried position. The current private practice based system in Norway seems best suited to the preferences of experienced GPs in urban communities.

Study objective-To assess whether populations with access to general practitioner hospitals (GP hospitals) utilise general hospitals less than populations without such access. Design-Observational study comparing the total rates of admissions and of occupied bed days in general hospitals between populations with and without access to GP hospitals. Comparisons were also made separately for diagnoses commonly encountered in GP hospitals. Setting-Two general hospitals serving the population of Finnmark county in north Norway. Patients-35 435 admissions based on five years' routine recordings from the two hospitals.Main results-The total rate of admission to general hospitals was lower in peripheral municipalities with a GP hospital than in central municipalities without this kind of institution, 26% and 28% lower for men and women respectively. The corresponding diVerences were 38% and 52%, when analysed for occupied bed days. The diVerences were most pronounced for patients with respiratory diseases, cardiac failure, and cancer who are primarily or intermediately treated or cared for in GP hospitals, and for patients with stroke and fractures, who are regularly transferred from general hospitals to GP hospitals for longer term follow up care. Conclusion-GP hospitals seem to reduce the utilisation of general hospitals with respect to admissions as well as occupied bed days. (J Epidemiol Community Health 1998;52:243-246) In Norway, general practitioner hospitals (GP hospitals) are small medical institutions on a level between primary care and general hospitals. They contain from two to around 20 beds and are usually located together with the GPs' surgery and the local nursing home in a joint facility. It is still questioned whether these institutions, as intended, relieve the pressure on general hospitals. In a previous study from Finnmark in north Norway it was estimated that 45% of the patients in the GP hospitals would have been admitted to general hospitals if the GP hospitals had not been available.1 It was also observed that patients transferred from general hospitals to GP hospitals for follow up care had the longest stays in the GP hospitals. Based on these findings it seems reasonable to anticipate that hospital admission rates are lower and that length of stay are shorter for populations with access to GP hospitals than for those without. An eight week survey indicated that this was the case particularly for conditions commonly cared for in GP hospitals.2 To explore this issue further, we have studied general hospital utilisation for a longer period in the same geographical area. The county of Finnmark is well suited for such a study because it still has 16 GP hospitals in active use and because 90% of GP hospital patients referred to higher level hospitals are admitted to the two county general hospitals. 2The aim of the study was to assess whether populations with access to a GP hospital utilise general hospital beds at a lower rate than populations without such access, particularly with respe...