title: Primary care utilization among patients with influenza during the 2009 pandemic. Does risk for severe influenza disease or prior contact with the general practitioner have any influence?
abstract: BACKGROUND
  Little is known about how patients belonging to risk groups for influenza used the primary care system during the influenza pandemic.
  
  
  OBJECTIVE
  To investigate the use of general practice and out-of-hours (OOH) services in patients with influenza-like illness (ILI) according to (i) risk for severe influenza disease and (ii) the number of regular general practitioner (GP) visits before the pandemic.
  
  
  METHODS
  Observational study of all ILI patients during the 2009 pandemic. Data were recorded prospectively and collected after the pandemic. Patients at risk were identified during an 18-month period by diagnoses from GPs' billing claims. Associations between risk factors for severe influenza disease and utilization of primary care were analysed using bivariate and multivariate regression analyses. Similar analyses were used for the association between number of GP visits before the pandemic and the primary care utilization during the pandemic.
  
  
  RESULTS
  ILI patients who were pregnant [odds ratio (OR) 1.70; 95% confidence interval (CI) 1.52, 1.89], had diabetes (OR 1.68; 95% CI 1.49, 1.89) or chronic lung disease (OR 1.44; 95 CI 1.34, 1.55) had increased risk of attending OOH services compared with patients with no risk factor. ILI patients with at least one GP visit prior to the pandemic used OOH services less during the pandemic compared with those with no GP visit.
  
  
  CONCLUSIONS
  An increased use of OOH services was found in ILI patients who were pregnant, with diabetes or with chronic lung disease. Having visited the GP before the pandemic was associated with less use of OOH services among ILI patients.
authors.affiliation: Research Group for General Practice, Department of Global Public Health and Primary Care, University of Bergen, Bergen Research Unit for General Practice, Uni Research Health, Bergen and kristian.simonsen@igs.uib.no.
authors.forename: Kristian A
authors.initials: KA
authors.lastname: Simonsen
authors.affiliation: Research Group for General Practice, Department of Global Public Health and Primary Care, University of Bergen, Bergen National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, Norway.
authors.forename: Steinar
authors.initials: S
authors.lastname: Hunskaar
authors.affiliation: National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, Norway.
authors.forename: Hogne
authors.initials: H
authors.lastname: Sandvik
authors.affiliation: Research Group for General Practice, Department of Global Public Health and Primary Care, University of Bergen, Bergen.
authors.forename: Guri
authors.initials: G
authors.lastname: Rortveit
mesh_terms: D000293:Adolescent; D000328:Adult; D039602:After-Hours Care / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007251:Influenza, Human / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009664:Norway / Q000453:epidemiology; D016017:Odds Ratio; D058873:Pandemics; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
keywords: After-hours care; general practitioners; influenza; pandemics; primary health care.