Hannes Kohnke

Continuity of care in Swedish primary care – an equality perspective

Continuity of care (CoC) is an essential aspect of primary care. In 2010 a health choice reform was instituted in Swedish primary care, changing premises for primary care and enabling new patterns of health care consumption, utilization, and continuity of care. The aim of this project is to describe CoC from an equality perspective and in regard to the health choice reform.

CoC refers to a long-term relationship between patient and physician and assumes responsibility for coordinating care as well as preventative measures. CoC in primary care has been reported to be positively associated to increased patient satisfaction, fewer emergency department visits, and lower health care costs.

In January 2010, the health choice reform was instituted in Swedish primary health care with the intention of increasing patients´ freedom of choice in their primary care provider, thus introducing a market competition amongst providers and creating incentives of improved quality of care. Since the reform, primary care professionals experience increasing difficulties in providing care with continuity and thus the aspect of CoC has been accentuated.

The purpose of the project is to investigate implications of CoC in primary health care on health care seeking behavior and how the health choice reform has affected CoC. Furthermore, the project intends to describe CoC from an equality perspective, i.e. if demographic or geographic determinants, through CoC, can be a cause of health inequality.

Patient data, including contacts to primary and specialized health care, will be retrieved from electronic patient databases in Region Skåne and Blekinge, from three years before the health choice reform until 7 years after and will be linked to morbidity measures and information from Statistics Sweden describing demographic or geographic determinants. Using statistical measures, associations between CoC and individual-, group- and organizational variables will be analyzed.

Effects of the health choice reform on CoC is inadequately described. This project will give new valuable insights on the effect of CoC on health care seeking behavior, effects of the health choice reform on CoC, and if low CoC in specific geographical regions or socioeconomic groups can explain differences in health inequality. In order to advance Swedish primary health care, the aspect of CoC needs further investigation. The results from this project will be of high relevance when planning for health care and in resource allocation, as well as contribute to greater health care equality.

Medicinska fakulteten, Lunds universitet
Main Supervisor: Anders Beckman, Associate professor, GP