Abstract

Background

Continuity of care (CoC) is accepted as a core value of primary care and is especially appreciated by patients with chronic conditions. Nevertheless, there are few studies investigating CoC for these patients across levels of healthcare.

Objective

This study aims to investigate CoC for patients with somatic chronic diseases, both with regular general practitioners (RGPs) and across care levels.

Methods

We conducted a registry-based observational study by using nationwide consultation data from Norwegian general practices, out-of-hours services, hospital outpatient care, and private specialists with public contracts. Patients with diabetes mellitus (type I or II), asthma, chronic obstructive pulmonary disease, or heart failure in 2012, who had ≥2 consultations with these diagnoses during 2014 were included. CoC was measured during 2014 by using the usual provider of care (UPC) index and Bice–Boxerman continuity of care score (COCI). Both indices have a value between 0 and 1.

Results

Patients with diabetes mellitus comprised the largest study population (N = 79,165) and heart failure the smallest (N = 4,122). The highest mean UPC and COCI were measured for patients with heart failure, 0.75 and 0.77, respectively. UPC increased gradually with age for all diagnoses, while COCI showed this trend only for asthma. Both indices had higher values in urban areas.

Conclusions

Our findings suggest that CoC in Norwegian healthcare system is achieved for a majority of patients with chronic diseases. Patients with heart failure had the highest continuity with their RGP. Higher CoC was associated with older age and living in urban areas.

中文翻译：

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慢性病患者护理的连续性：来自挪威的一项基于注册的观察性研究

摘要

背景

护理连续性 (CoC) 被认为是初级保健的核心价值，尤其受到慢性病患者的赞赏。然而，很少有研究调查这些患者在不同医疗保健水平上的 CoC。

客观的

本研究旨在调查具有常规全科医生 (RGP) 和不同护理级别的躯体慢性疾病患者的 CoC。

方法

我们通过使用来自挪威全科诊所、非工作时间服务、医院门诊护理和拥有公共合同的私人专家的全国咨询数据进行了一项基于注册的观察性研究。纳入 2012 年患有糖尿病（I 型或 II 型）、哮喘、慢性阻塞性肺病或心力衰竭的患者，这些患者在 2014 年接受过 2 次以上这些诊断的会诊。CoC 在 2014 年通过使用常规护理提供者 (UPC) 指数和 Bice-Boxerman 护理连续性评分 (COCI) 进行测量。两个索引的值都在 0 和 1 之间。

结果

糖尿病患者的研究人群最多（N = 79,165），心力衰竭患者人数最少（N = 4,122）。心力衰竭患者的最高平均 UPC 和 COCI 分别为 0.75 和 0.77。对于所有诊断，UPC 随着年龄的增长逐渐增加，而 COCI 仅在哮喘中显示出这种趋势。这两个指数在城市地区都有较高的值。

结论

我们的研究结果表明，挪威医疗保健系统中的 CoC 是为大多数慢性病患者实现的。心力衰竭患者的 RGP 连续性最高。较高的 CoC 与年龄较大和居住在城市地区有关。