Associations between primary healthcare and unplanned medical admissions in Norway: a multilevel analysis of the entire elderly population

BMJ Open. 2014 Apr 12;4(4):e004293. doi: 10.1136/bmjopen-2013-004293.

Abstract

Objective: To examine if individual risk of unplanned medical admissions (UMAs) was associated with municipality general practitioner (GP) or long-term care (LTC) volume among the entire Norwegian elderly population.

Design: Cross-sectional population-based study.

Setting: 428 of 430 Norwegian municipalities in 2009.

Participants: All Norwegians aged ≥65 years (n=721 915; 56% women-15% of the total population).

Main outcome measure: Individual risk of UMA.

Results: Using a multilevel analytical framework, consisting of individuals (N=722 464) nested within municipalities (N=428), nested within local hospital areas (N=52) we found no association between municipality GP or LTC volume and UMAs. However, we found that higher LTC levels of provision were associated with fewer hospitalisations among the older age groups. A modest geographical variability was observed for UMA in adjusted analysis.

Conclusions: A higher primary healthcare volume was only associated with fewer UMAs among the oldest old in a universally accessible healthcare system.

Keywords: Long-term Care; Primary Care; Small Area Analyses; Unplanned Admissions.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Cross-Sectional Studies
  • Female
  • Hospitalization / statistics & numerical data*
  • Humans
  • Long-Term Care / statistics & numerical data
  • Male
  • Norway / epidemiology
  • Primary Health Care / statistics & numerical data*
  • Sex Factors