Trends in acute specialist contacts following a primary care contact 2012-21-a registry-based study

Acute patients in Norway can access specialist services through various pathways, with primary care services having a gatekeeping role. Although national data show declining acute specialist contacts, some emergency departments report increasing visits. This study examined national trends in acute specialist contacts following primary care visits.

This registry-based cohort study included all Norwegian citizens from 2012 to 2021. We obtained information on patients' contact with primary care (general practitioner (GP) service and out-of-hours service) before an acute specialist contact. Acute specialist contacts occuring within 10 h of a primary care contact were considered referrals. Incidence rates were estimated using Poisson regression.

Among 12.2 million acute specialist contacts, 21.8% had a preceding out-of-hours service contact, 19.2% had a preceding GP service contact, and 58.9% had no prior primary care contact. From 2012 to 2021, the incidence rate of acute specialist contacts following a primary care contact increased by 18.5% (95% CI: 17.9-19.1), from 91.8 to 109.3 per 1,000 person-years. This trend was observed across all demographic groups, and for both admissions and outpatient visits. The increase was most pronounced for referrals following the out-of-hours service (46.6 to 59.3 per 1,000 person-years), while GP service referrals remained stable.

Acute specialist contacts declined over time, while the proportion and incidence rate of those following a primary care contact increased, particularly following out-of-hours services. The consistent trend across demographic groups suggests that changes in healthcare organisation and service use, rather than population changes, are contributing to the observed trend.