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BMC Primary Care
Published in: BMC Primary Care 1/2017

Open Access 01-12-2017 | Research article

Practice variation in surgical procedures and IUD-insertions among general practitioners in Norway – a longitudinal study

Authors: Andreas Saxlund Pahle, Daniel Sørli, Ivar Sønbø Kristiansen, Trygve S. Deraas, Peder A. Halvorsen

Published in: BMC Primary Care | Issue 1/2017

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Abstract

Background

Studies of Primary Health Care (PHC) reveal considerable practice variations in terms of the range of services provided. In Norway, general practitioners (GPs) are traditionally expected to perform IUD-insertions and several surgical procedures as a part of comprehensive PHC. We aimed to investigate variation in the provision of surgical procedures and IUD-insertions across GPs and over time and explore determinants of such variation.

Methods

Retrospective registry study of Norwegian GPs. From a comprehensive database of GPs’ reimbursement claims, we obtained procedure codes and GP characteristics such as age, gender, list size and municipality characteristics from 2006 through 2013. Multivariable logistic regression models were fitted to explore determinants of practice variation.

Results

We extracted data from 4,828 GPs. In 2013, 91.0, 76.1 and 74.8% were reimbursed at least once for minor and major surgical procedures and IUD-insertion, respectively. Female GPs had lower odds for performing major surgical procedures (OR 0.38, 95% CI 0.32–0.45) and higher odds for performing IUD-insertions (OR 6.28, 95% CI 4.47–8.82) than male GPs. Older GPs and GPs with shorter patient lists were less likely to perform surgical procedures. GPs with longer patient lists had higher odds for performing IUD-insertions. The proportion of GPs performing surgical procedures increased over time, while the proportion decreased for IUD-insertions. The number of IUD-insertions in specialist care increased from 12,575 in 2011 to 15 216 (+21.0%) in 2014.

Conclusion

We observed a large variation in the provision of surgical procedures and IUD-insertions amongst GPs in Norway. The GPs’ age, gender, list size and size of municipality were associated with performing the procedures. Our findings suggest a shift of IUD-insertions from primary to specialist care.
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Metadata
Title
Practice variation in surgical procedures and IUD-insertions among general practitioners in Norway – a longitudinal study
Authors
Andreas Saxlund Pahle
Daniel Sørli
Ivar Sønbø Kristiansen
Trygve S. Deraas
Peder A. Halvorsen
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2017
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-017-0581-9

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