Characterstics of middle-aged frequent attenders and their use of helthcare professionals’ services within public primary, occupational and private healthcare:population-based cohort study in northern Finland

Abstract Background: The characteristics of frequent attenders have been studied extensively; however, there is a scarce literature on the frequent attenders’ use of different healthcare sectors’ and professionals’ services. Aims: To characterise middle-aged frequent attenders (FAs) of the public primary healthcare (PPHC), and to examine their use of healthcare professionals’ services across PPHC, occupational (OHC), and private healthcare (PHC). Methodology: The data used is part of the Northern Finland Birth Cohort 1966’s 46-year follow-up study collected in 2012, during which 5484 cohort members answered to a questionnaire about use of healthcare services. A FA was defined as a patient who had made ≥ 8 PPHC visits within the previous year. Cross-tabulation, and binary logistic regression analysis were used. Results: FAs (n=519, 9.5%) primarily used PPHC services, whereas their use of PHC and OHC services was much lower (45.5%, 9.5%, and 10.2% of all consultations, respectively). Within the PPHC, FAs used a wide variety of services provided by different healthcare professionals, particularly those offered by physiotherapists (198 FAs used 81.8% of services) and psychologists (85 FAs used 88.5% of services). Unemployment, drawing a disability pension, ex-smoking, poor or decent self-reported health, having ≥ 2 chronic health conditions (p≤0.001), having one chronic health condition (p≤0.01), female gender, dissatisfaction with the current life situation, abstinence from alcohol, heavy drinking, and BMI ≥ 30 (p<0.05) seemed to be associated with frequent attendance. Conclusions: FAs have complex needs and seem to use primarily different healthcare professionals’ services within public primary healthcare, whereas their use of private and occupational healthcare services is noticeably lower. Frequent attenders’ service use includes a wide variety of healthcare providers’ services in addition to physicians’ services

Inflammatory hallmarks of lesser prominence in psoriatic arthritis patients starting biologics: a Nordic population-based cohort study.

To access publisher's full text version of this article click on the hyperlink belowObjectives: To assess secular trends in baseline characteristics of PsA patients initiating their first or subsequent biologic DMARD (bDMARD) therapy and to explore prescription patterns and treatment rates of bDMARDs from 2006 to 2017 in the Nordic countries. Methods: PsA patients registered in the Nordic rheumatology registries initiating any treatment with bDMARDs were identified. The bDMARDs were grouped as original TNF inhibitor [TNFi; adalimumab (ADA), etanercept (ETN) and infliximab (IFX)]; certolizumab pegol (CZP) and golimumab (GOL); biosimilars and ustekinumab, based on the date of release. Baseline characteristics were compared for the five countries, supplemented by secular trends with R2 calculations and point prevalence of bDMARD treatment. Results: A total of 18 089 patients were identified (Denmark, 4361; Iceland, 449; Norway, 1948; Finland, 1069; Sweden, 10 262). A total of 54% of the patients were female, 34.3% of patients initiated an original TNFi, 8% CZP and GOL, 7.5% biosimilars and 0.3% ustekinumab as a first-line bDMARD. Subsequent bDMARDs were 25.2% original TNFi, 9% CZP and GOL, 12% biosimilars and 2.1% ustekinumab. From 2015 through 2017 there was a rapid uptake of biosimilars. The total of first-line bDMARD initiators with lower disease activity increased from 2006 to 2017, where an R2 close to 1 showed a strong association. Conclusion: Across the Nordic countries, the number of prescribed bDMARDs increased from 2006 to 2017, indicating a previously unmet need for bDMARDs in the PsA population. In recent years, PsA patients have initiated bDMARDs with lower disease activity compared with previous years, suggesting that bDMARDs are initiated in patients with a less active inflammatory phenotype. Keywords: bDMARDs; international collaborations; prescription patterns; psoriatic arthritis; secular trends of inflammatory hallmarks.NordForsk FOREUM OAK Foundatio