Geographic variation in patient continuity and discontinuity in general practice in Region of Southern Denmark - a retrospective registry-based study

Abstract

Abstract Background It is well known that patients in general practice live in health care systems where geography may be their destiny because of different circumstances in different geographic locations. Therefore, it is important to explore the variation in continuity of care to understand this central characteristic of the health care system. Aim To describe the geographic variation in continuity and discontinuity of care for patients listed in general practices across municipalities and between urban and rural areas in the Region of Southern Denmark. Methods This was a retrospective cohort registry study of patients older than 12 years who were enrolled in general practice in 22 municipalities in the Region of Southern Denmark from 2007–2018. Continuity of care is here the length of enrollment with a general practice, and discontinuity of care is the number of times a patient changes general practice. The data are based on civil registration numbers for patients, general practice provider numbers, patient age at each change of their general practice, and data on the municipality where each patient has their address. Results The cohort included 982,644 patients in 22 municipalities. The average duration of enrollment per patient at a general practice was 7.9 years. A total of 27.1% of patients had been enrolled for 0–5 years, 28.7% for 5–10 years and 44.2% for more than ten years. Discontinuity in terms of the number of changes between practices revealed that 44.7% of patients had no discontinuity, 28.7% had experienced one change in general practice, 13.8% had two changes, 6.3% had three changes, and 7.1% had four or more changes. The average number of times a patient changes their general practice was 1.14. Compared to rural municipalities, there is a trend toward more discontinuity and shorter times of enrollment in general practice in urban municipalities. Conclusions There was a significant difference between urban and rural settings, where at least a portion of patients in urban municipalities had shorter enrollments in general practice and more frequent changes between practices. Given that many patients change their general practice, focusing on how to address discontinuity is recommended.