Use of general practitioner services among high-cost older patients in somatic hospitals - a Norwegian registry-based...

General practitioners (GP) play a vital role in ensuring comprehensive and integrated healthcare to older adults with substantial use of somatic hospitals services. These patients, often referred to as high-cost older patients, use a substantial proportion of specialized healthcare resources, but less is known about their use of primary care and GP services. This study aims to explore the frequency of the use of GP services among high-cost older patients and other older patients admitted to Norwegian somatic hospitals and identify characteristics associated with the frequency of service use.

This is an observational cross-sectional study using registry data of older Norwegian patients (≥65 years) with ≥1 unplanned contact with somatic hospitals in 2019 (n = 212,022). We used a negative binomial regression model to analyze the frequency of use of GP services and associations with patient characteristics. GP services include all contact types (consultations, home visits, interprofessional contacts, brief contacts, and administrative contacts). Both adjusted and unadjusted results were reported to provide a comprehensive understanding of the data. The high-cost group was defined as patients with the 10% highest diagnosis-related-group weights.

A total of 183,847 patients, consisting of 18,440 high-cost and 165,407 non-high-cost older patients were included in the regression analysis. The unadjusted average frequency of GP contacts was 24.4 for the high-cost group and 16.6 for the non-high-cost group. After adjusting for the different characteristics in the two groups, the high-cost group still had a higher frequency of GP contacts compared to the non-high-cost older group. Several characteristics were associated with higher expected frequency of GP contacts, including older age, being female, and having multiple main diagnoses, multiple contacts with out-of-hours services, and/or longer hospital stay.

The high-cost group had higher utilization of GP services across various contact types compared to other older adults. The healthcare utilization of high-cost older patients appears to transcend the context of somatic hospitals, as they could be deemed frequent users of GP services. Additionally, the association between GP service use and patient characteristics might indicate that groups known to have higher healthcare needs also use more services.