Correction to: General practitioners’ and out-of-hours doctors’ role as gatekeeper in emergency admissions to somatic hospitals in Norway: registry-based observational study

Blinkenberg, Jesper; Pahlavanyali, Sahar; Hetlevik, Øystein; Sandvik, Hogne; Hunskaar, Steinar

doi:10.1186/s12913-020-05590-y

Cited by 9 publications

(16 citation statements)

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“…Sex, ethnicity, and education level are other variables that may influence health, the use of health services, and mortality. Since there are geographical differences in the use of hospitals and OOH services, 23,24 the analysis also adjusted for a rural-urban variable (centrality). It is possible that healthy patients with few visits may have long continuity without the benefit of being well known by their RGP.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Continuity in general practice as predictor of mortality, acute hospitalisation, and use of out-of-hours care: a registry-based observational study in Norway

et al. 2021

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BackgroundContinuity, usually considered a quality aspect of primary care, is under pressure in Norway, and elsewhere.AimTo analyse the association between longitudinal continuity with a named regular general practitioner (RGP) and use of out-of-hours (OOH) services, acute hospital admission, and mortality.Design and settingRegistry-based observational study in Norway covering 4 552 978 Norwegians listed with their RGPs.MethodDuration of RGP–patient relationship was used as explanatory variable for the use of OOH services, acute hospital admission, and mortality in 2018. Several patient-related and RGP-related covariates were included in the analyses by individual linking to high-quality national registries. Duration of RGP–patient relationship was categorised as 1, 2–3, 4–5, 6–10, 11–15, or >15 years. Results are given as adjusted odds ratio (OR) with 95% confidence intervals (CI) resulting from multilevel logistic regression analyses.ResultsCompared with a 1-year RGP–patient relationship, the OR for use of OOH services decreased gradually from 0.87 (95% CI = 0.86 to 0.88) after 2–3 years’ duration to 0.70 (95% CI = 0.69 to 0.71) after >15 years. OR for acute hospital admission decreased gradually from 0.88 (95% CI = 0.86 to 0.90) after 2–3 years’ duration to 0.72 (95% CI = 0.70 to 0.73) after >15 years. OR for dying decreased gradually from 0.92 (95% CI = 0.86 to 0.98) after 2–3 years’ duration, to 0.75 (95% CI = 0.70 to 0.80) after an RGP–patient relationship of >15 years.ConclusionLength of RGP–patient relationship is significantly associated with lower use of OOH services, fewer acute hospital admissions, and lower mortality. The presence of a dose–response relationship between continuity and these outcomes indicates that the associations are causal.

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Section: Strengths and Limitationsmentioning

confidence: 99%

Continuity in general practice as predictor of mortality, acute hospitalisation, and use of out-of-hours care: a registry-based observational study in Norway

et al. 2021

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“…The primary care contact prior to admission might be random, and not related to the admission. In a previous study we found a distinct accumulation of GP and OOH contacts within 24 h before acute hospital admission [ 9 , 10 ]. This indicates that the assumption that a contact within 24 h before an admission is the referral contact, is valid.…”

Section: Discussionmentioning

confidence: 99%

“…For referrals with abdominal and chest pain symptoms, the most frequent ICD-10 discharge diagnoses were the corresponding symptom-based diagnoses abdominal and pelvic pain (R10) and pain in throat and chest (R07). Our previous study showed that these discharge diagnoses were the overall second and third most frequent discharge diagnoses after acute admissions to hospital, irrespective of referral agent [ 9 , 10 ]. Such extensive use of symptom diagnoses both in referrals and discharges could serve as a reminder of the diagnostic challenges in both primary care and in hospitals but might as well be an indication of defensive medicine.…”

Section: Discussionmentioning

confidence: 99%

“…Norway has a well-established public primary healthcare system including a Regular General Practitioners scheme (RGPs) and OOH services [ 9 , 10 ]. RGPs provide healthcare for both acute and non-acute cases including follow up, whereas the OOH services provide care in acute cases outside the opening hours of RGPs’ surgeries.…”

Section: Methodsmentioning

confidence: 99%

“…In the Norwegian healthcare system, the GPs and OOH doctors are gatekeepers to specialist care, including hospital admissions, for all kind of emergencies, including traumas. In a previous study we found that two thirds of acute admissions to hospitals in Norway 2014 came after contact with a GP or an OOH-doctor [ 9 , 10 ], the rest were direct admissions of different kinds.…”

Section: Introductionmentioning

confidence: 99%

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Reasons for acute referrals to hospital from general practitioners and out-of-hours doctors in Norway: a registry-based observational study

Blinkenberg

Hetlevik

Sandvik

et al. 2022

BMC Health Serv Res

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Background General practitioners (GPs) and out-of-hours (OOH) doctors are gatekeepers to acute hospital admissions in many healthcare systems. The aim of the present study was to investigate the whole range of reasons for acute referrals to somatic hospitals from GPs and OOH doctors and referral rates for the most common reasons. We wanted to explore the relationship between some common referral diagnoses and the discharge diagnosis, and associations with patient’s gender, age, and GP or OOH doctor referral. Methods A registry-based study was performed by linking national data from primary care in the physicians’ claims database with hospital services data in the Norwegian Patient Registry (NPR). The referring GP or OOH doctor was defined as the physician who had sent a claim for the patient within 24 h prior to an acute hospital stay. The reason for referral was defined as the ICPC-2 diagnosis used in the claim; the discharge diagnoses (ICD-10) came from NPR. Results Of all 265,518 acute hospital referrals from GPs or OOH doctors in 2017, GPs accounted for 43% and OOH doctors 57%. The overall referral rate per contact was 0.01 from GPs and 0.11 from OOH doctors, with large variations by referral diagnosis. Abdominal pain (D01) (8%) and chest pain (A11) (5%) were the most frequent referral diagnoses. For abdominal pain and chest pain referrals the most frequent discharge diagnosis was the corresponding ICD-10 symptom diagnosis, whereas for pneumonia-, appendicitis-, acute myocardial infarction- and stroke referrals the corresponding disease diagnosis was most frequent. Women referred with chest pain were less likely to be discharged with ischemic heart disease than men. Conclusions The reasons for acute referral to somatic hospitals from GPs and OOH doctors comprise a wide range of reasons, and the referral rates vary according to the severity of the condition and the different nature between GP and OOH services. Referral rates for OOH contacts were much higher than for GP contacts. Patient age, gender and referring service influence the relationship between referral and discharge diagnosis.

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Primary care doctors in acute call-outs to severe trauma incidents in Norway – associations with factors related to patients and doctors

Myklevoll,

Zakariassen,

Morken

et al. 2023

Scandinavian Journal of Primary Health Care

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Objective Severe trauma patients need immediate prehospital intervention and transfer to a specialised trauma hospital. In Norway, primary care doctors (PCDs) are an integrated part of the prehospital trauma care. The aim of this study was to investigate the degree to which PCDs were involved in prehospital care of severe trauma patients and how factors related to patients and doctors were associated with call-outs to these incidents. Design This was a registry-based study in Norway on severe trauma patients with acute hospital admission during the period 2012–2018. Setting Data was obtained from three Norwegian official registries. Subjects By linking the registries, we studied the actions taken by the PCDs, whether they called out to severe trauma incidents. Main outcome measures In multivariable regression models, we investigated whether factors related to the PCDs (age, sex, specialisation in general practice (GP)) and patients (age, sex, duration of hospital stay, type of injury) were associated with call-outs. Results Out of 4342 severe trauma incidents, PCDs had documented involvement in 1683 (39%) and called out to 644 (15%). Increased proportions of PCD call-outs to severe trauma incidents were significantly associated with lower age of PCD, being a GP specialist, lower patient age, being a male patient, increased length of hospital stay and injuries to the head and the neck. Conclusions PCDs called out to a relatively low proportion of severe trauma patients. Several factors related to patients and doctors were associated with call-outs to severe trauma incidents in Norway.

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Correction to: General practitioners’ and out-of-hours doctors’ role as gatekeeper in emergency admissions to somatic hospitals in Norway: registry-based observational study

Abstract: An amendment to this paper has been published and can be accessed via the original article.

Cited by 9 publications

References 1 publication

Continuity in general practice as predictor of mortality, acute hospitalisation, and use of out-of-hours care: a registry-based observational study in Norway

Continuity in general practice as predictor of mortality, acute hospitalisation, and use of out-of-hours care: a registry-based observational study in Norway

Reasons for acute referrals to hospital from general practitioners and out-of-hours doctors in Norway: a registry-based observational study

Primary care doctors in acute call-outs to severe trauma incidents in Norway – associations with factors related to patients and doctors

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