Lack of GP continuity increases mortality in several chronic diseases

Lower GP continuity is linked with increased mortality in patients with several chronic diseases, a study has found.

Patients with COPD, diabetes and heart failure, who see a regular named GP for their condition have lower rates of mortality than those who do not, the study of Norwegian primary care consultation data found.

The effect was particularly pronounced for COPD in the bottom quartile on a continuity scale with a 47% increased risk of dying within two years than those rated in the top quartile.

Similar patterns were seen when researchers looked at all consultations and not just those for the specific condition.

But the association was not seen with asthma, the researchers reported in the British Journal of General Practice, which they said was likely to be because it was a much larger population with lower mortality overall.

But the team also wanted to look at what happened when that personal list was ‘breached’ and the patient moved GP.

They explained that while patients in Norway have high levels of continuity because the Government introduced a personal list system in 200, every year about 15% of the population change their regular GP, either at the patients’ discretion or because GPs leave or retire.

There have been changes over time with workload pressures, increased use of locums and the prioritising of access over continuity, they explained.

The analysis showed that the association between continuity and mortality was not that different when a patient changed their regular GP suggesting that having a well-functioning list system with good information and management systems could ‘compensate for the adverse effects when changing GP’.

Study lead Sahar Pahlavanyali from the Department of Global Public Health and Primary Care at the University of Bergen said the research could help guide policy makers on who should be a priority for continuity.

‘When it comes down to prioritising patients with chronic disease and older patients since studies have shown that they have a lot of benefit but it’s very important to keep in mind that providing continuity of care does not involve only chronic care consultations in order for GP to build a relationship with their patients.

‘In Norway we have this personal list system and when it works properly it already provides some continuity for all the patients and that can be both personal continuity but also informational and management continuity.’

She added that they had expected to find some difference between continuity of care and mortality for those who had the same regular GP and those who changed their regular GP during the four-year study.

But it was likely that patients were becoming registered with another GP in the same practice providing some protective affect against the negative impact of lower continuity, she explained.