Active listing and more consultations in primary care are associated with reduced hospitalisation in a Swedish population

Abstract

BackgroundHealthcare systems are complex networks where relationships affect outcomes. The importance of primary care increases while health care acknowledges multimorbidity, the impact of combinations of different diseases in one person. Active listing and consultations in primary care could be used as proxies of the relationships between patients and primary care. Our objective was to study hospitalisation as an outcome of primary care, exploring the associations with active listing, number of consultations in primary care and two groups of practices, while taking socioeconomic status and morbidity burden into account.MethodsA cross-sectional study using zero-inflated negative binomial regression to estimate odds of any hospital admission and mean number of days hospitalised for the population over 15 years (N = 123,168) in the Swedish county of Blekinge during 2007. Explanatory factors were listed as active or passive in primary care, number of consultations in primary care and primary care practices grouped according to ownership. The models were adjusted for sex, age, disposable income, education level and multimorbidity level.ResultsMean days hospitalised was 0.94 (95%CI 0.90–0.99) for actively listed and 1.32 (95%CI 1.24–1.40) for passively listed. For patients with 0–1 consultation in primary care mean days hospitalised was 1.21 (95%CI 1.13–1.29) compared to 0.77 (95%CI 0.66–0.87) days for patients with 6–7 consultations. Mean days hospitalised was 1.22 (95%CI 1.16–1.28) for listed in private primary care and 0.98 (95%CI 0.94–1.01) for listed in public primary care, with odds for hospital admission 0.51 (95%CI 0.39–0.63) for public primary care compared to private primary care.ConclusionsActive listing and more consultations in primary care are both associated with reduced mean days hospitalised, when adjusting for socioeconomic status and multimorbidity level.Different odds of any hospitalisation give a difference in mean days hospitalised associated with type of primary care practice.To promote well performing primary care to maintain good relationships with patients could reduce mean days hospitalised.

Active listing and more consultations in primary care are associated with shorter mean hospitalisation and interacting with psychiatric disorders when adjusting for multimorbidity, age and sex

“…Studies on predictors of high quality primary care have also stated that longer consultations and good teamwork are important for quality of care [28,29]. Previously we have studied mean days hospitalised as an outcome of primary care, accounting for socioeconomic factors also analysing difference between primary care practices [25]. Both our studies show that active listing and more than mean consultations in primary care lower mean days hospitalised, adjusting for morbidity burden.…”

“…Our use of a coherent Swedish healthcare system tried to control for such factors. Mean days hospitalised and relationships with primary care have recently been studied for this population accounting for socioeconomic factors [25] showing decreasing mean days hospitalised with active listing and more consultations in primary care.…”

Dementia diagnostics in primary care : with a focus on cognitive testing

“…In a recent Swedish study, the result showed that active patient -doctor listing and more consultations in primary care are associated with reduced mean days hospitalised, when adjusting for socioeconomic status and multimorbidity level. In conclusion, the promotion of well performing primary care is worthwile to maintain good relationships with patients and possibly reduce mean days hospitalised (48). The risk of hospitalisation is increased in relation to morbidity burden and is therefore of particular interest in relation to elderly patients and individuals with cognitive impairment.…”

Primary care workforce development in Europe: An overview of health system responses and stakeholder views

“…NCDs' [12, p.4-5]. Comparative studies have shown that strong primary care systems achieve better health outcomes and better results in relation to both cost-containment and reducing inequality in access to, and accessibility of, care; they also support more effective service utilisation elsewhere in the health system [3][4][13][14][15][16].…”

“…Sweden is also committed to an integrated and people-centred model of primary care with some gatekeeping. Care is usually provided by multi-professional teams in larger centres, but there is variation between the different Counties and between the urban and remote (especially Arctic) areas [16,40].…”