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 of care, that is the tradition of patients having an ongoing relationship with a regular GP and care team which has characterised health care for more than a century, is essential to the delivery of good health outcomes particularly in vulnerable communities. Unlike hospital care, where patient interactions with health and medical staff are based on an episode of a particular disease or injury, continuity is not limited by the type of disease and bridges episodes of various illnesses. Greater continuity with a primary care physician has been shown to be associated with lower mortality rates, fewer hospital admissions, less use of emergency departments, and fewer referrals for specialist health care. Yet, continuity of care with a GP has been declining in recent years due to the withdrawal of hospital services (GP/VMO roles in particular) from rural and remote communities which makes general practice unviable in these regions, and the increased focus of universities on producing specialist doctors to advance academic research agendas. This study adds to the extensive research which shows that having a regular GP for 15 years or more leads to a 25-30% reduction in out of hours health care demand, a reduction in acute hospital admission and decreased mortality. In short, continuity would reduce the current demand to build more hospitals, the overcrowding of emergency departments and the high rate of preventable deaths in rural and remote communities.