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Background: While some patients GP have a continuous GP-patient-relationship, others see their GP occasionally and tend to switch GPs. The 8-item F-HABI questionnaire accesses the intensity of a patient´s commitment to see their GP as on-going primary care provider. Higher scores indicate greater commitment (Range: 0-24).

Aim/scientific question: The aim of this study is to assess on a larger scale if social determinants and the presence of specific chronic conditions are associated with a patient´s willingness to use his / her GP as the primary healthcare provider and first contact to the healthcare system.

Material & Methods: The Hamburg City Health Study (HCHS) is a large, prospective, long-term, population-based cohort study that started in 2016 aiming to include 45,000 inhabitants aged 45–74 years until 2028. During a 7-h examination, participants answer validated questionnaires including the F-HABI and undergo examinations of different organ systems. HCHS-data of 16.411 participants was analysed. Statistical significance was evaluated by Student´s T-Tests and linear regression analyses.

Results: Our dataset comprised 13,131 participants with a completed F-HABI questionnaire. Mean age was 60.8 ± 8.6 years, 50.7% were female, and 21.7% were privately insured. CASMIN educational levels were 17.8% (CASMIN-1), 33.6% (CASMIN-2), and 48.6% (CASMIN-3). Common chronic conditions included hypertension (64.4%), asthma (10.3%), diabetes (9.2%), coronary artery disease (7.4%), and chronic obstructive pulmonary disease (6.8%). In our multivariable linear regression, lower F-HABI scores were most strongly associated with private health insurance (B = -2.14, 95% CI -2.41 to -1.88), CASMIN-3 education (B = -1.69, 95% CI -2.02 to -1.35), and the highest personal net income (B = -1.40, 95% CI -2.13 to -0.66). Higher F-HABI scores were associated with age 65–79 years (B = 1.71, 95% CI 1.42 to 2.00), a native language other than German (B = 1.07, 95% CI 0.66 to 1.48), and chronic conditions overall (significant B coefficients: 0.07 to 0.90).

Discussion: In our population-based sample of urban adults aged 45–79 years, socioeconomic determinants were more strongly associated with GP commitment, as measured by the F-HABI score, than common chronic diseases. We conclude that participants´ perceived need for primary healthcare appears to be influenced more by social status than by chronic conditions.

Take Home Message: Socioeconomic advantage — not chronic disease burden — was the strongest correlate of lower GP commitment in our large population-based sample.

Competing interests: None