Active listing and more consultations in primary care are associated with reduced hospitalisation in a Swedish population

Karin Ranstad, Patrik Midlöv, Anders Halling

Healthcare systems are complex networks where relationships affect outcomes. The importance of primary care increases while health care acknowledges multimorbidity, the impact of combinations of different diseases in one person. Active listing and consultations in primary care could be used as proxies of the relationships between patients and primary care. Our objective was to study hospitalisation as an outcome of primary care, exploring the associations with active listing, number of consultations in primary care and two groups of practices, while taking socioeconomic status and morbidity burden into account. A cross-sectional study using zero-inflated negative binomial regression to estimate odds of any hospital admission and mean number of days hospitalised for the population over 15 years (N = 123,168) in the Swedish county of Blekinge during 2007. Explanatory factors were listed as active or passive in primary care, number of consultations in primary care and primary care practices grouped according to ownership. The models were adjusted for sex, age, disposable income, education level and multimorbidity level. Mean days hospitalised was 0.94 (95%CI 0.90-0.99) for actively listed and 1.32 (95%CI 1.24-1.40) for passively listed. For patients with 0-1 consultation in primary care mean days hospitalised was 1.21 (95%CI 1.13-1.29) compared to 0.77 (95%CI 0.66-0.87) days for patients with 6-7 consultations. Mean days hospitalised was 1.22 (95%CI 1.16-1.28) for listed in private primary care and 0.98 (95%CI 0.94-1.01) for listed in public primary care, with odds for hospital admission 0.51 (95%CI 0.39-0.63) for public primary care compared to private primary care. Active listing and more consultations in primary care are both associated with reduced mean days hospitalised, when adjusting for socioeconomic status and multimorbidity level. Different odds of any hospitalisation give a difference in mean days hospitalised associated with type of primary care practice. To promote well performing primary care to maintain good relationships with patients could reduce mean days hospitalised.