Consultation frequency for older patients in general practice: A nationwide cohort study of patient- and practice related factors

Abstract Background Older patients account for most contacts in general practice. The contacts can be divided into five types: Face-to-face, telephone, e-mail, home visits, and chronic care reviews. Variations in contact types and frequencies across general practices can be caused by differences in patient populations, local circumstances, and individual preferences. This study aims to analyse how patient and general practice characteristics are associated with the frequency of consultation types in general practice for older patients as well as to analyse variation in consultation frequency. Methods Register-based nationwide cohort study of all Danish citizens aged ≥75 years in 2017-2021. The practices’ frequencies of daytime consultations were analysed using zero-inflated Poisson regression adjusted for patient population characteristics. Funnel plots were used to assess variation in daytime consultations. Results Danish general practices had on average 10 total annual consultations per citizen aged ≥75 years, comprising 3.7 face-to-face-, 3.3 telephone-, 2.2 e-mail consultations, 0.61 home visits, and 0.38 chronic care reviews. The largest total numbers of consultations were found for patients with 10+ unique drugs, high use of home healthcare services, nursing home residency, and high multimorbidity. Non-western ethnicity was associated with fewer consultations and non-attendance. Nine percent of general practices showed larger variation in total annual consultations than could be explained by chance after adjusting for patient factors. Conclusion Age, multimorbidity, and polypharmacy were key drivers of consultation frequency. Nine percent of general practices provide more or fewer yearly consultations than expected based on population characteristics. Trial registration The study is based on a published protocol July 27, 2023: https://doi.org/10.1136/bmjopen-2023-073229