Chronic care services and variation between Danish general practices: a nationwide cohort study

The British journal of general practice: the journal of the Royal College of General Practitioners

article

Anders Prior¹  Claus Høstrup Vestergaard²  Anette Riisgaard Ribe²  Annelli Sandbæk³  Flemming Bro¹  Peter Vedsted²  Susan Smith⁴  Mogens Vestergaard¹  Morten Fenger-Grøn² 

[1] Research Unit for General Practice, Aarhus, Department of Public Health, Aarhus University;Research Unit for General Practice;Department of Public Health, Aarhus University, Aarhus, Steno Diabetes Center Aarhus, Aarhus University Hospital;Department of General Practice, RCSI University of Medicine and Health Sciences

关键词: chronic disease;    cohort studies;    general practitioners;    health services research;    primary health care;   

DOI  :  10.3399/BJGP.2021.0419

学科分类：卫生学

来源: Royal College of General Practitioners

【 摘 要 】

Background Little is known about variations in the provision of chronic care services in primary care.Aim To describe the frequency of chronic care services provided by GPs and analyse the extent of non-random variation in service provision.Design and setting Nationwide cohort study undertaken in Denmark using data from 2016.Method Information on chronic care services was obtained from national health registers, including annual chronic care consultations, chronic care procedures, outreach home visits, and talk therapy. The associations between services provided, patient morbidity, and socioeconomic factors were estimated. Service variations were analysed, and excess variation related to practice-specific factors was estimated while accounting for random variation.Results Chronic care provision was associated with increasing patient age, increasing number of long-term conditions, and indicators of low socioeconomic status. Variation across practices ranged from 1.4 to 128 times more than expected after adjusting for differences in patient population and random variation. Variation related to practice-specific factors was present for all the chronic care services that were investigated. Older patients with lower socioeconomic status and multimorbidity were clustered in practices with low propensity to provide certain chronic care services.Conclusion Chronic care was provided to patients typically in need of health care, that is, older adults, those with multimorbidity, and those with low socioeconomic status, but service provision varied more than expected across practices. GPs provided slightly fewer chronic care services than expected in practices where many patients with multimorbidity and low socioeconomic status were clustered, suggesting inverse care law mechanisms.

【 授权许可】

Free