Frequent attenders of three outpatient health care schemes in Finland: characteristics and association with long-term sickness absences, 2016–2018

Abstract

Objectives Frequent attenders (FAs) impose a significant burden on service capacity and public health funding. Although the characteristics of the group and their risk for sickness absences (SA) have been studied, an understanding of FAs in different health care schemes is lacking. The aim of the study was to investigate FAs and their SA risk in the working-age population in public care, occupational health services (OHS) and private care schemes. The average number of SA days was also examined by diagnostic group. Setting and participants Register data on the use of outpatient health care, sickness allowance spells and background characteristics (2015–2018) for 25–64 year old residents of the city of Oulu, Finland, (n = 91,737) were used. Subjects were categorized into non-attenders, non-frequent attenders and FAs (top decile of attenders) both for all outpatient health care and specifically for each care scheme in 2016. The number of sickness absence days was measured yearly in 2016, 2017 and 2018. The data were analyzed with descriptive methods and negative binomial regression models. Results FAs consumed 31 to 44% of all visits depending on scheme in 2016. Frequent attendance was common among low socioeconomic groups in the public scheme, among lower non-manual employees and manual workers in OHS, and among entrepreneurs in the private scheme. FAs had a higher average number of SA days than others in each scheme, although group differences decreased from 2016 to 2017 and 2018. In public care, the adjusted effect of frequent attendance was strong especially for SA due to mental disorders (adjusted incidence rate ratio [IRR] for FAs 13.40), and in OHS for SA due to musculoskeletal disorders (adjusted IRR for FAs 8.68). Conclusion In each outpatient health care scheme, frequent attenders pose a great challenge both by consuming services and through their increased risk of disability. FAs in different schemes have partially different characteristics and risks. Common patient registers covering various service schemes would enable an identification of FAs visiting multiple schemes and services. Better coordinated services are needed for public care FAs in particular.

Parallel use of primary and secondary healthcare by frequent attenders in occupational health and their work disability: a longitudinal study in Finland

“…Additionally, sociodemographic factors such as occupational class and education are also known to be linked to work disability and service use. 14 19–22 Social determinants of health that include gender, education and employment act as background variables impacting on the occurrence and severity of disability 23 and thus should be taken into consideration when studying factors related to work disability.…”

“…Primary healthcare may be organised in several different ways, but FA creates a a marked and roughly same kind of demand—the top 10% constitutes 30%‒40% of visits in primary care, although there is evidence that FAs create a greater demand in the public sector 1 11 14. Primary care in Finland is provided through several healthcare sectors (public, private and OH), which may allow for parallel service use across for example public and OH primary care 15 16.…”

“…As FAs in OHS primary care are more likely to receive a disability grant than other users,4 it can be presumed that their illnesses are more severe and that they need secondary care consultations. Additionally, sociodemographic factors such as occupational class and education are also known to be linked to work disability and service use 14 19–22. Social determinants of health that include gender, education and employment act as background variables impacting on the occurrence and severity of disability23 and thus should be taken into consideration when studying factors related to work disability.…”

Associations of Medical Visits with Dentist Visits: A Register-Linkage Study of a Working-Age Population in Finland

“…Irrespective of need of care, those with higher socioeconomic status are more likely to utilize medical and dental services [1][2][3][4][5]. At the same time, among those who use health care, the most frequent health care attenders have been shown to come from vulnerable groups in terms of chronic sickness [6,7] and socioeconomic background [7][8][9]. While the focus has been on the socioeconomic, morbidity, and demographic characteristics among attenders of either medical or dental care [1][2][3][4][5], very little is known about how the utilization of medical services itself is related to the attendance of dental health care.…”

“…Previous studies have focused on either the sectoral utilization of medical services [1,2,4] and frequent attenders [6][7][8][9], or the sectoral utilization of dental care [5,[13][14][15]. Studies that have addressed the joint-utilization of medical and dental services are scarce and surveybased [21][22][23][24], and have not taken into account the different health care sectors.…”