Development of office-hours use of primary health centers in the early years of the 21st century : a 13-year longitudinal follow-up study

This study, conducted in a Finnish city, examined whether a long-lasting observed trend in Finnish primary health care, namely, a decreasing rate of office-hour visits to general practitioners (GPs), would lead to reduced services for specific gender, diagnosis or age groups. This was an observational retrospective follow-up study. The annual number of visits to office-hour primary care GPs in different gender, diagnosis and age groups was recorded during a 13-year follow-up period. The effect of the decreasing visit rate on the annual mortality rate in different age and gender groups was also studied. The total number of monthly visits to office-hour GPs decreased slowly over the whole study period. This decrease was stronger in women and older people. The proportion of recorded infectious diseases (Groups A and J and especially diagnoses related to infections of respiratory airways) decreased. Proportions of recorded chronic diseases increased (Group I, cardiovascular diseases, diabetes and osteoarthrosis) during the follow-up. The annual rate of visits to office-hour GP/per GP decreased. There was a decrease in the mortality in two of the age groups (20-64, 65+ years) and no change in the youngest population (0-19 years). The decrease in the office-hours GP activity does not seem to increase mortality either.Peer reviewe

Development of the use of primary health care emergency departments after interventions aimed at decreasing overcrowding : a longitudinal follow-up study

Background This study, conducted in a Finnish city, examined whether decreasing emergency department (ED) services in an overcrowded primary care ED and corresponding direction to office-hours primary care would modify service usage for specific gender, age or diagnosis groups. Methods This was an observational retrospective study carried out by gradually decreasing ED services in primary care. The interventions aimed at decreasing use of EDs were a) application of ABCDE-triage combined with public guidance on the proper use of EDs, b) closure of a minor supplementary ED, and finally, c) application of "reverse triage" with enhanced direction of the public to office-hours services and away from the remaining ED The annual number of visits to office-hours primary care GPs in different gender, age and diagnosis groups (International Classification of Diseases (ICD - 10) were recorded during a 13-year follow-up period. Results The total number of monthly visits to EDs decreased slowly over the whole study period. This decrease was similar in women and men. The decrease was stronger in the youngest age groups (0-19 years). GPs treated decreasing proportions of ICD-10 groups. Recorded infectious diseases (Groups A and J, and especially diagnoses related to infections of respiratory airways) tended to decrease. However, visits due to injuries and symptomatic diagnoses increased. Conclusion Decreasing services in a primary health care ED with the described interventions seemed to reduce the use of services by young people. The three interventions mentioned above had the effect of making the primary care ED under study appear to function more like a standard ED driven by specialized health care.Peer reviewe