Associations between primary healthcare and unplanned medical admissions in Norway: a multilevel analysis of the entire elderly population

OBJECTIVE To examine if individual risk of unplanned medical admissions (UMAs) was associated with municipality general practitioner (GP) or long-term care (LTC) volume among the entire Norwegian elderly population. DESIGN Cross-sectional population-based study. SETTING 428 of 430 Norwegian municipalities in 2009. PARTICIPANTS All Norwegians aged ≥65 years (n=721 915; 56% women-15% of the total population). MAIN OUTCOME MEASURE Individual risk of UMA. RESULTS Using a multilevel analytical framework, consisting of individuals (N=722 464) nested within municipalities (N=428), nested within local hospital areas (N=52) we found no association between municipality GP or LTC volume and UMAs. However, we found that higher LTC levels of provision were associated with fewer hospitalisations among the older age groups. A modest geographical variability was observed for UMA in adjusted analysis. CONCLUSIONS A higher primary healthcare volume was only associated with fewer UMAs among the oldest old in a universally accessible healthcare system.