Continuity of GP care is associated with lower use of complementary and alternative medical providers: a population-based cross-sectional survey

BMC Health Services Research

Peder A Halvorsen¹  Olaug S Lian²  Agnete E Kristoffersen³  Anne Helen Hansen² 

[1] General Practice Research Unit, Department of Community Medicine, University of Tromsø - The Arctic University of Norway, Tromsø, Norway;Faculty of Health Sciences, Department of Community Medicine, University of Tromsø - The Arctic University of Norway, Tromsø, Norway;The National Research Center in Complementary and Alternative Medicine (NAFKAM), University of Tromsø - The Arctic University of Norway, Tromsø, Norway

关键词: Norway;    Cross-sectional study;    Complementary and alternative medical providers;    Primary health care;    General practice;    Continuity of patient care;   

Others  :  1090094
DOI  :  10.1186/s12913-014-0629-7

 received in 2014-05-20, accepted in 2014-12-02,  发布年份 2014

【 摘 要 】

Background

Continuity of general practitioner (GP) care is associated with reduced use of emergency departments, hospitalisation, and outpatient specialist services. Evidence about the relationship between continuity and use of complementary and alternative medical (CAM) providers has so far been lacking. The aim of this study was to test the association between continuity of GP care and the use of CAM providers.

Methods

We used questionnaire data from the sixth Tromsø Study, conducted in 2007–8. Using descriptive statistical methods, we estimated the proportion using a CAM provider among adults (30–87 years) who had visited a GP during the last 12 months. By means of logistic regressions, we studied the association between the duration of the GP-patient relationship and the use of CAM providers. Analyses were adjusted for the frequency of GP visits, gender, age, marital status, income, education, and self-rated health and other proxies for health care needs.

Results

Of 9,743 eligible GP users, 85.1% had seen the same GP for more than two years, 83.7% among women and 86.9% among men. The probability of visiting a CAM provider was lower among those with a GP relationship of more than 2 years compared to those with a shorter GP relationship (odds ratio [OR] 0.81, 95% confidence interval [CI] 0.68-0.96). Other factors associated with CAM use were female gender, poor health, low age and high income. There was no association with education.

Conclusions

Continuity of GP care as measured by the duration of the GP-patient relationship was associated with lower use of CAM providers. Together with previous studies this suggests that continuity of GP care may contribute to health care delivery from fewer providers.

【 授权许可】

   
2014 Hansen et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Haggerty JL, Reid RJ, Freeman GK, Starfield BH, Adair CE, McKendry R: Continuity of care: a multidisciplinary review. BMJ 2003, 327(7425):1219-1221.
• [2]Freeman G, Hughes J: Continuity of care and the patient experience. GP inquiry paper. The King’s Fund, London; 2010.
• [3]Hjortdahl P, Laerum E: Continuity of care in general practice: effect on patient satisfaction. BMJ 1992, 304(6837):1287-1290.
• [4]Aboulghate A, Abel G, Elliott MN, Parker RA, Campbell J, Lyratzopoulos G, Roland M: Do English patients want continuity of care, and do they receive it? Br J Gen Pract 2012, 62(601):e567-e575.
• [5]Saultz JW, Albedaiwi W: Interpersonal continuity of care and patient satisfaction: a critical review. Ann Fam Med 2004, 2(5):445-451.
• [6]Saultz JW, Lochner J: Interpersonal continuity of care and care outcomes: a critical review. Ann Fam Med 2005, 3(2):159-166.
• [7]O'Connor PJ, Desai J, Rush WA, Cherney LM, Solberg LI, Bishop DB: Is having a regular provider of diabetes care related to intensity of care and glycemic control? J Fam Pract 1998, 47(4):290-297.
• [8]Sturmberg JP, Schattner P: Personal doctoring. Its impact on continuity of care as measured by the comprehensiveness of care score. Aust Fam Physician 2001, 30(5):513-518.
• [9]Menec VH, Sirski M, Attawar D: Does continuity of care matter in a universally insured population? Health Serv Res 2005, 40(2):389-400.
• [10]Hansen AH, Halvorsen PA, Aaraas IJ, Førde OH: Continuity of GP care is related to reduced specialist healthcare use: a cross-sectional survey. Br J Gen Pract 2013, 63(612):482-489.
• [11]Gray DP, Evans P, Sweeney K, Lings P, Seamark D, Seamark C, Dixon M, Bradley N: Towards a theory of continuity of care. J R Soc Med 2003, 96(4):160-166.
• [12]Finnvold JE, Svalund J: Continuity between doctor and patient: mixed results of the GP reform. Samfunnsspeilet 2004, 2:27-33. (in Norwegian)
• [13]Guthrie B, Saultz JW, Freeman GK, Haggerty JL: Continuity of care matters. BMJ 2008, 337:a867.
• [14][https://lovdata.no/dokument/NL/lov/2003-06-27-64] webcite Law on alternative treatment of disease, etc.ACT −2003-06-27-64. §2. (in Norwegian).
• [15][https://lovdata.no/dokument/NL/lov/1999-07-02-64?q=helsepersonelloven] webcite Health Personnel Act.ACT-1999-07-02-64. §48. (in Norwegian).
• [16]Fischer FH, Lewith G, Witt CM, Linde K, von Ammon K, Cardini F, Falkenberg T, Fønnebø V, Johannessen H, Reiter B, Uehleke B, Weidenhammer W, Brinkhaus B: High prevalence but limited evidence in complementary and alternative medicine: guidelines for future research. BMC Complement Altern Med 2014, 14:46. BioMed Central Full Text
• [17]Hansen AH, Halvorsen PA, Førde OH: The ecology of medical care in Norway: wide use of general practitioners may not necessarily keep patients out of hospitals. J Public Health Res 2012, 1:e28.
• [18]Salamonsen A: Doctor-patient communication and cancer patients' choice of alternative therapies as supplement or alternative to conventional care. Scand J Caring Sci 2013, 27(1):70-76.
• [19]Furnham A, Bhagrath R: A comparison of health beliefs and behaviours of clients of orthodox and complementary medicine. Br J Clin Psychol 1993, 32(Pt 2):237-246.
• [20]D'Crus A, Wilkinson JM: Reasons for choosing and complying with complementary health care: an in-house study on a South Australian clinic. J Altern Complement Med 2005, 11(6):1107-1112.
• [21]Murray J, Shepherd S: Alternative or additional medicine? An exploratory study in general practice. Sos Sci Med 1993, 37(8):983-988.
• [22]Tasaki K, Maskarinec G, Shumay DM, Tatsumura Y, Kakai H: Communication between physicians and cancer patients about complementary and alternative medicine: exploring patients' perspectives. Psychooncology 2002, 11(3):212-220.
• [23]Djuv A, Nilsen OG, Steinsbekk A: The co-use of conventional drugs and herbs among patients in Norwegian general practice: a cross-sectional study. BMC Complement Altern Med 2013, 13:295. BioMed Central Full Text
• [24][http://www.tromso.kommune.no/allmennlegekontor.121249.no.html] webcite GPs in Tromsø Municipality. [] (in Norwegian).
• [25][http:/ / w2.brreg.no/ altbas/ utovere_treffliste.jsp?behandlingsf orm=0&etternavn=&fornavn=®ionsnr =100&fylkesnr=19&kommunenr=1902] webcite The Register of CAM Practitioners. [] (in Norwegian).
• [26][http://www.forskning.no/artikler/2012/juni/323777] webcite GP still on top. [] (in Norwegian).
• [27][http:/ / www.helsedirektoratet.no/ finansiering/ refusjonsordninger/ tall-og-analyser/ fastlege/ Sider/ statistikk-om-fastlegene.aspx] webcite Statistics about the GPs. [] (in Norwegian).
• [28][http:/ / nsddata.nsd.uib.no/ webview/ index.jsp?study=http%3A%2F%2Fnsddat a.nsd.uib.no%3A80%2Fobj%2FfStudy%2F NSD1327&studydoc=http%3A%2F%2Fnsdda ta.nsd.uib.no%3A80%2Fobj%2FfStudy%2 FNSD1327&mode=documentation&submode =abstract&v=2&top=yes] webcite Norwegian Survey of Living Conditions 2008. [] (in Norwegian).
• [29][https://www.nav.no/Forsiden/_attachment/90350?=true&_ts=11bdab23d78] webcite Management data for the GP scheme Q2 2008. [] (in Norwegian).
• [30]Steinsbekk A, Adams J, Sibbritt D, Jacobsen G, Johnsen R: The profiles of adults who consult alternative health practitioners and/or general practitioners. Scand J Prim Health Care 2007, 25(2):86-92.
• [31]Hanssen B, Grimsgaard S, Launsø L, Fønnebø V, Falkenberg T, Rasmussen NK: Use of complementary and alternative medicine in the Scandinavian countries. Scand J Prim Health Care 2005, 23(1):57-62.
• [32][http:/ / uit.no/ ansatte/ organisasjon/ artikkel?p_menu=42374&p_document_id =104991&p_dimension_id=88111] webcite The Tromsø Study website. []
• [33]Eggen AE, Mathiesen EB, Wilsgaard T, Jacobsen BK, Njølstad I: The sixth survey of the Tromso Study (Tromso 6) in 2007–08: collaborative research in the interface between clinical medicine and epidemiology: study objectives, design, data collection procedures, and attendance in a multipurpose population-based health survey. Scand J Public Health 2013, 41(1):65-80.
• [34]Coretti S, Ruggeri M, McNamee P: The minimum clinically important difference for EQ-5D index: a critical review. Expert Rev Pharmacoecon Outcomes Res 2014, 14(2):221-233.
• [35][http:/ / www.regjeringen.no/ nb/ dep/ hod/ dok/ regpubl/ stmeld/ 2008-2009/ stmeld-nr-47-2008-2009-.html?id=567 201] webcite Norwegian Ministry of Health and Care Services: The Coordination Reform - proper Treatment - at the right Place and Time. Report No. 47 to the Storting. 2009. (in Norwegian).
• [36]Willcox S, Lewis G, Burgers J: Strengthening primary care: recent reforms and achievements in Australia, England, and the Netherlands. Issue Brief (Commonw Fund) 2011, 27:1-19.
• [37]O'Malley AS, Tynan A, Cohen GR, Kemper N, Davis MM: Coordination of care by primary care practices: strategies, lessons and implications. Res Brief 2009, 12:1-16.
• [38]Hansen AH, Halvorsen PA, Ringberg U, Førde OH: Socio-economic inequalities in health care utilisation in Norway: a population based cross-sectional survey. BMC Health Serv Res 2012, 12:336. BioMed Central Full Text
• [39]Steinsbekk A, Adams J, Sibbritt D, Jacobsen G, Johnsen R: Socio-demographic characteristics and health perceptions among male and female visitors to CAM practitioners in a total population study. Forsch Komplementarmed 2008, 15(3):146-151.
• [40]Steinsbekk A, Rise MB, Johnsen R: Changes among male and female visitors to practitioners of complementary and alternative medicine in a large adult Norwegian population from 1997 to 2008 (The HUNT studies). BMC Complement Altern Med 2011, 11:61. BioMed Central Full Text
• [41]Bishop FL, Lewith GT: Who uses CAM? A narrative review of demographic characteristics and health factors associated with CAM use. Evid-based Compl Alt: eCAM 2010, 7(1):11-28.
• [42]Steinsbekk A, Rise MB, Aickin M: Cross-cultural comparison of visitors to CAM practitioners in the United States and Norway. J Altern Complement Med 2009, 15(11):1201-1207.
• [43][http://www.ssb.no/en/utdanning/statistikker/utniv] webcite Population’s level of education. []
• [44][http://statbank.ssb.no/statistikkbanken/] webcite Bank of Statistics. []
• [45]Bertakis KD, Azari R, Helms LJ, Callahan EJ, Robbins JA: Gender differences in the utilization of health care services. J Fam Pract 2000, 49(2):147-152.
• [46]Bertakis KD: The influence of gender on the doctor-patient interaction. Patient Educ Couns 2009, 76(3):356-360.
• [47]Sandhu H, Adams A, Singleton L, Clark-Carter D, Kidd J: The impact of gender dyads on doctor-patient communication: a systematic review. Patient Educ Couns 2009, 76(3):348-355.
• [48]Berger S, Braehler E, Ernst J: The health professional-patient-relationship in conventional versus complementary and alternative medicine. A qualitative study comparing the perceived use of medical shared decision-making between two different approaches of medicine. Patient Educ Couns 2012, 88(1):129-137.
• [49]Sweeney KG, Gray DP: Patients who do not receive continuity of care from their general practitioner - are they a vulnerable group? Br J Gen Pract 1995, 45(392):133-135.
• [50]Mainous AG 3rd, Baker R, Love MM, Gray DP, Gill JM: Continuity of care and trust in one's physician: evidence from primary care in the United States and the United Kingdom. Fam Med 2001, 33(1):22-27.
• [51]van Haselen RA, Reiber U, Nickel I, Jakob A, Fisher PA: Providing complementary and alternative medicine in primary care: the primary care workers' perspective. Complement Ther Med 2004, 12(1):6-16.
• [52][http:/ / blogs.psychcentral.com/ mindfulness/ 2011/ 03/ nothing-that-is-human-is-alien-maya -angelo-and-terence/ ] webcite Nothing That is Human is Alien: Maya Angelou and Terence. []
• [53]Galea S, Tracy M: Participation rates in epidemiologic studies. Ann Epidemiol 2007, 17(9):643-653.
• [54]Hetlevik Ø, Gjesdal S: Personal continuity of care in Norwegian general practice: a national cross-sectional study. Scand J Prim Health Care 2012, 30(4):214-221.
• [55]Kristoffersen AE, Fønnebø V, Norheim AJ: Use of complementary and alternative medicine among patients: classification criteria determine level of use. J Altern Complement Med 2008, 14(8):911-919.
• [56]Reijneveld SA, Stronks K: The validity of self-reported use of health care across socioeconomic strata: a comparison of survey and registration data. Int J Epidemiol 2001, 30(6):1407-1414.