Associations between primary healthcare and unplanned medical admissions in Norway: A multilevel analysis of the entire elderly population

摘要

Objective: To examine if individual risk of unplannedmedical admissions (UMAs) was associated withmunicipality general practitioner (GP) or long-term care(LTC) volume among the entire Norwegian elderlypopulation.Design: Cross-sectional population-based study.Setting: 428 of 430 Norwegian municipalities in 2009.Partic ipants: All Norwegians aged ≥65 years(n=721 915; 56% women—15% of the totalpopulation).Main outcome measure: Individual risk of UMA.Results: Using a multilevel analytical framework,consisting of individuals (N=722 464) nested withinmunicipalities (N=428), nested within local hospitalareas (N=52) we found no association betweenmunicipality GP or LTC volume and UMAs. However,we found that higher LTC levels of provision wereassociated with fewer hospitalisations among the olderage groups. A modest geographical variability wasobserved for UMA in adjusted analysis.Conclus ions: A higher primary healthcare volume wasonly associated with fewer UMAs among the oldest oldin a universally accessible healthcare system.