ABSTRACT
OBJECTIVE: To assess the use of general practitioners (GPs), in elderly home-dwelling persons in Norway and explore the impact of cognitive decline, age, and living situation. DESIGN: Prospective longitudinal study. SETTING: Data were collected from municipalities in four counties in Norway in the period from January 2009 to August 2012. SUBJECTS: Home-dwelling persons 70 years of age or older, receiving in-home care. MAIN OUTCOME MEASURES: Use of GPs over a period of 18 months related to cognitive state, functional status, neuropsychiatric symptoms, and demographics. RESULTS: A total of 599 persons were included. The mean annual number of consultations per participant was 5.6 (SD = 5.4). People with moderate to severe dementia had fewer consultations per year compared with those with mild or no dementia (3.7 versus 5.8 per year, p = 0.004). In the multivariate model higher age predicted fewer consultations while affective neuropsychiatric symptoms were associated with an increase in frequency of consultations. The most frequent reason to consult a GP was cardiovascular diseases (36.8% of all consultations), followed by musculoskeletal complaints (12.1%) and psychiatric diagnoses (8.7%). CONCLUSION: Our study shows that the home-dwelling elderly with moderate to severe dementia in Norway consult their GP less often than persons with mild or no dementia. This could indicate a need for better interaction between the municipal care and social services and the general practitioners.
Subject(s)
Dementia , General Practice , Health Services for the Aged/statistics & numerical data , Patient Acceptance of Health Care , Age Factors , Aged , Aged, 80 and over , Dementia/therapy , Female , General Practitioners , Health Services Needs and Demand , Home Care Services , Humans , Longitudinal Studies , Male , Motivation , Norway , Practice Patterns, Physicians' , Prospective Studies , Referral and ConsultationABSTRACT
In the Norwegian capitation trial, the payment system for general practitioners (GPs) has been changed; a practice allowance component has been replaced by a capitation component and the fee-per-item component constitutes a smaller part of a GPs practice income than previously. From the theoretical modelling of GPs' referral decisions, we predict that the replacement of the practice allowance by a capitation component will increase the rate of referrals to specialists. This hypothesis is supported by an exploratory empirical study with data from a sample of GPs participating in the experiment.