Importance of healthcare utilization and multimorbidity level in choosing a primary care provider in Sweden

Objective. To study the associations between active choice of primary care provider and healthcare utilization, multimorbidity, age, and sex, comparing data from primary care and all healthcare in a Swedish population. Design. Descriptive cross-sectional study using descriptive analyses including t-test, correlations, and logistic regression modelling in four separate models. Setting and subjects. The population (151 731) and all healthcare in Blekinge in 2007. Main outcome measure. Actively or passively listed in primary care, registered on 31 December 2007. Results. Number of consultations (OR 1.31, 95% CI 1.30-1.32), multimorbidity level (OR 1.69, 95% CI 1.67-1.70), age (OR 1.03, 95% CI 1.03-1.03), and sex (OR for men 0.67, 95% CI 0.65-0.68) were all associated with registered active listing in primary care. Active listing was more strongly associated with number of consultations and multimorbidity level using primary care data (OR 2.11, 95% CI 2.08-2.15 and OR 2.14, 95% CI 2.11-2.17, respectively) than using data from all healthcare. Number of consultations and multi-morbidity level were correlated and had similar associations with active listing in primary care. Modelling number of consultations, multimorbidity level, age, and sex gave four separate models with about 70% explanatory power for active listing in primary care. Combining number of consultations and multimorbidity did not improve the models. Conclusions. Number of consultations and multimorbidity level were associated with active listing in primary care. These factors were also associated with each other differently in primary care than in all healthcare. More complex models including non-health-related individual characteristics and healthcare-related factors are needed to increase explanatory power.