More discontinuity for vulnerable patients in their contact with general practice

Patients with low income, a low level of education, unemployment or ethnic backgrounds other than Danish are more likely than others to change general practice – as are patients with chronic diseases and patients who live in certain regions of the country.

This is according to a new national register study from the Danish Centre for Health Economics and the Research Unit of General Practice at the University of Southern Denmark.

A change of doctor can be due to, for example, the patient moving or the practice closing, but also the patient choosing to switch to another doctor.

- When patients repeatedly change general practice or experience changes, it is likely that not only continuity but also important knowledge, relations and accountability in care are lost. This increases the risk of errors and makes the healthcare system less efficient, says Troels Kristensen, associate professor and health economist.

Patients in intermediate municipalities experience the most continuity of care

The study also shows that patients in so-called intermediate municipalities – areas that are neither clearly rural nor urban – experience the highest continuity and the fewest changes of general practice.

The researchers suggest that this may be due to structural or organisational conditions that support stable medical contact. They encourage the lessons learnt to be used in other municipalities with high patient mobility and a shortage of doctors.

Regional differences can be due to organisation

The study also shows that patients in Region Zealand and the Capital Region of Denmark have a significantly higher likelihood of experiencing disruptions in their contact with general practice – even when differences in age, gender, disease and socio-economic background are taken into account.

According to the researchers, this may point to organisational differences in general practice among the regions – and should prompt reflection in light of the planned merger of the two regions into one large region.

- We find that patients in the Capital Region of Denmark and Zealand have a higher risk of discontinuity – even when we adjust for social and health differences. This suggests that the organisation of general practice may play a role, says Troels Kristensen, associate professor and health economist.

Chronically ill people also switch general practices

At the same time, the study shows that patients with chronic diseases also experience many changes of doctor – a group one would have expected to require particularly stable and continuous care from a regular team of healthcare professionals in general practice. This challenges the notion that those most in need of treatment experience the most continuity.

- We expected lower discontinuity among patients with chronic conditions. Instead, we see that these patients have an unexpectedly high risk of discontinuity – and this can cause concern and afford grounds for further investigation, says Troels Kristensen.

Loss of relationship and risk of error

Breaks in continuity can lead to the loss of important knowledge and the personal relationship between doctor and patient – which increases the risk of errors, repeated examinations for the same issue and lack of follow-up. According to the researchers, this can ultimately jeopardise patient health and lead to poorer treatment, while placing an undue burden on the healthcare system. Only in rare cases – for example, when following an outdated treatment plan or looking at a problem blindly – can a fresh perspective be beneficial.

- Continuity is not just a matter of patient safety – it is crucial for both the quality and the efficiency of the treatment, says Peder Ahnfeldt-Mollerup, GP and co-author of the study.

- When the same groups are repeatedly overrepresented among frequent switchers, it reveals a structural problem.

The researchers: Look to the places where it works

According to the researchers, the study provides important guidance for healthcare policymakers and administrators. At a time when recruitment of GPs is a major concern and pressure on local healthcare is increasing, there is a need to ensure more stable care pathways – particularly for vulnerable groups and in geographical areas with a shortage of doctors.

The researchers call for a closer look at the intermediate municipalities in which continuity is high and for using their experiences in the planning of general practice in other parts of the country.