Examining variation in general practice consultation frequencies for older adults: a nationwide register study

BACKGROUND: In the Danish healthcare system, primary care for the growing population of older adults is provided by around 1600 independently owned general practices with a high degree of autonomy in service delivery. AIM: To investigate practice-level variation in consultation frequencies for older adults in Denmark and its association with practice-level factors, after adjustment for patient characteristics. DESIGN & SETTING: Register-based nationwide cohort study of all Danish residents aged ≥75 years listed with a general practice in 2017-2021. METHOD: The practices' consultation frequencies were analysed using zero-inflated Poisson regression adjusted for patient population factors. Funnel plots assessed variation in consultations. Multinomial logistic regression was used for analysing associations between practice factors and exhibiting systematic variation in consultation frequency. RESULTS: In 2017, the study included 468 679 older adults, rising to 569 457 in 2021. In 2021, the average consultation frequency was 10, comprising 3.7 face to face, 3.3 telephone, 2.2 email, 0.61 home visit, and 0.38 chronic care review consultations. After adjusting for the practices' patient population, 4%-9% of general practices showed greater variation in consultation frequency than could be explained by chance. No practice-level factors - number of GPs, their age, sex, or years since specialist qualification - were associated with providing more consultations than expected. CONCLUSION: The systematic variation in consultation frequencies between practices is notable. Further studies should explore the potential consequences for patients registered with a general practice exhibiting consultation frequencies that differ significantly from other practices beyond what could be explained by chance.