Going Digital or Stayin’ Clinical?: Modelling Primary Health Care Consultation Types Using Register Data from Sweden

Abstract

Background: Primary health care clinics use several different types of consultations, including on-site visits and remote contacts to see patients. However, it is not clear what factors determine the choice of consultation type taking into consideration the full spectrum of options. Objectives: This study uses national register data from Sweden on all primary care consultations in the years 2019 to 2022 (N = 15,3-19,5 million) to model four types of consultations: office visits, digital contacts (text messages or video), home visits, and telephone/letter contacts. Methods: The modelling of consultation type takes the cross-sectional, panel, and multilevel structure of the data into consideration fitting multinomial logistic models while controlling for patient, clinic, and context factors. Results: In the current context, the choice of consultation type is determined by both patient (age, socioeconomic status, diagnosis) and clinic (public or private) factors, as well as context factors (reimbursement mechanism). From a policy perspective, only weak evidence is found to suggest that paying clinics for digital contacts increases those types of consultations. Conclusions: The findings may inform the development and implementation of policies and regulations to improve the delivery of primary health care in similar contexts.