Continuity and discontinuity of care among older patients in Danish general practice: a retrospective cohort study

Background: Continuity of care (COC) for older adults has been associated with lower use of healthcare services, decreased risk of hospitalisation, and lower mortality. However, research on COC in older adults is limited by short time periods and small sample sizes. Long- term COC can only develop if the patient stays with the general practice for >= 10 years. Therefore, research that focuses on long duration and broader populations is needed. Aim: To measure the extent of longitudinal site- level COC in general practice and listing duration of the patient-general practice relation for all older Danish citizens. Design & setting: Retrospective cohort study of all patients aged >= 65 years on 31 December 2021 listed with a Danish general practice (N = 1 144 941 persons). Method: Individual- level register data were used on start and end dates for listing with a general practice to analyse site-level COC by number of changes and listing duration of the patient-general practice relation from January 2007-December 2021. Results: During the 15 years, 39.3% of older adults did not change general practice. Among the remaining 60.7%, who experienced discontinuity of care, 34.0% changed once, 16.3% changed twice, and 6.3% changed three times. Overall, <5% changed general practice >3 times. The duration of the patient-general practice relations were on average 9.5 years. Overall, 27.5% lasted 0-4 years, 33.7% lasted 5-9 years, and 38.8% lasted >= 10 years. Conclusion: Danish general practice provides high levels of site- level COC for their older patients. On average, patients aged >= 65 years changed general practice once and had a patient-general practice relation length of 9.5 years.