Vulnerable patients experience more breaks in contact with general practice

A new nationwide study from the University of Southern Denmark (SDU) shows that patients with low socioeconomic status, chronic illness, and residence in the Capital Region or Region Zealand are more likely to change general practitioners (in this context, “general practitioner” refers to a medical practice or clinic – ed.). This can have consequences for treatment, health equity, and public healthcare spending.

Patients with low income, short education, unemployment, or a different ethnic background change GP practices more often than others – and the same applies to people with chronic illnesses or those living in specific parts of the country. This is shown in a new national registry study from the Danish Centre for Health Economics and the Research Unit for General Practice at the University of Southern Denmark.

Changes in general practitioners may, for instance, be due to relocation or practice closure, but also when the patient actively chooses to change doctor.

– When patients repeatedly change GP practices, it is likely that they not only lose continuity but also important knowledge, relationships, and accountability in care. This increases the risk of errors and makes the healthcare system less efficient, says associate professor and health economist Troels Kristensen.

The study includes data from more than 4.5 million Danes and reveals how certain groups experience more breaks in their connection to general practice – what researchers call discontinuity. Most people experienced one or two changes, but some had many more, especially young adults and patients in the Capital Region and Region Zealand.

Patients in mid-sized municipalities have the most stable attachment

The study shows that patients in so-called mid-sized municipalities – areas that are neither clearly rural nor urban – have the highest continuity and the fewest changes of general practice.

Researchers suggest this may be due to structural or organizational factors that support stable GP contact. They recommend that experiences from these municipalities be used in others with high patient mobility and low doctor coverage.

Regional differences may stem from organization

The study also shows that patients in Region Zealand and the Capital Region are significantly more likely to experience breaks in contact with general practice – even after adjusting for differences in age, gender, illness, and socioeconomic background.

According to the researchers, this points to possible organizational differences in how general practice is structured between the regions – and should prompt reflection, especially in light of the planned merger of the two regions into one large administrative unit.

– We find that patients in the Capital Region and Region Zealand have a higher risk of discontinuity – even when we control for social and health-related differences. This suggests that the organization of general practice may play a role, says Troels Kristensen.

Chronically ill patients also change practices

At the same time, the study shows that patients with chronic illnesses also experience frequent changes. This is a group that would be expected to have a strong need for stable attachment to a consistent team of healthcare professionals in general practice. This challenges the assumption that the most care-intensive patients automatically receive continuous care.

– We had expected that patients with chronic illnesses would have a more stable attachment to their practice. Instead, we see that these patients have an unexpectedly high risk of discontinuity – which is cause for concern and highlights the need for further investigation, says Troels Kristensen.

Loss of relationship and increased risk of errors

Breaks in continuity can result in the loss of important knowledge and personal relationships between doctor and patient – increasing the risk of errors, repeated testing for the same issues, and lack of follow-up. According to the researchers, this can ultimately harm the patient’s health and lead to poorer treatment outcomes, while putting unnecessary strain on the healthcare system. Only in rare cases – for example, when following an outdated treatment plan – can a fresh perspective be beneficial.

– Continuity is not just about patient comfort – it is essential for both the quality and efficiency of care, says general practitioner and co-author Peder Ahnfeldt-Mollerup.

– When the same groups are repeatedly overrepresented among those with frequent changes, it reveals a structural problem.

Researchers: Learn from where it works

According to the researchers, the study provides important guidance for health policymakers and administrators. In a time of increasing attention on GP recruitment and growing pressure on local healthcare services, there is a need to ensure more stable care pathways – especially for vulnerable groups and in geographic areas with low doctor coverage.

The researchers urge decision-makers to look closely at mid-sized municipalities where continuity is high and apply their experiences to planning general practice in other parts of the country.