چکیده (انگلیسی):

Background:Norwegian general practitioners (GPs) consult on a variety of conditions with a mix of patient types.
Patients with chronic diseases benefit from appropriate continuity of care and generally visit their GPs more often
than the average patient. Our aim was to study disenrollment patterns among patients with chronic diseases in
Norway, because such patterns could indicate otherwise unobserved GP quality. For instance, higher quality GPs
could have both a greater share of patients with chronic diseases and lower disenrollment rates.
Methods:Data on 384,947 chronic patients and 3,974 GPs for the years 2009–2011 were obtained from national
registers, including patient and GP characteristics, disenrollment data, and patient list composition. The birth cohorts
from 1940 and 1970 (146,906 patients) were included for comparison. Patient and GP characteristics, comorbidity, and
patient list composition were analyzed using descriptive statistics. Patients’ voluntary disenrollment was analyzed using
logistic regression models.
Results:The GPs’ proportion of patients with a given chronic disease varied more than expected when the allocation
was purely random. The proportions of patients with different chronic diseases were positively correlated, partly due to
comorbidity. Patients tended to have lower disenrollment rates from GPs who had higher shares of patients with
the same chronic disease. Disenrollment rates were generally lower from GPs with higher shares of patients with
arthritis or depression, and higher from GPs who had higher shares of patients with diabetes type 1 and schizophrenia.
This was the same in the comparison group.
Conclusion:Patients with a chronic disease appeared to prefer GPs who have higher shares of patients with the same
disease. High shares of patients with some diseases were also negatively associated with disenrollment for all patient
groups, while other diseases were positively associated. These findings may reflect the GPs’ general quality, but could
alternatively result from the GPs’ specialization in particular diseases. The supportive findings for the comparison group
make it more plausible that high shares of chronic patients could indicate GP quality.