Patients’ assessments of the continuity of primary care in Finland: a 15-year follow-up questionnaire survey

Abstract

BackgroundContinuity of care is an essential aspect of quality in general practice. This study is the first systematic follow-up of Finnish primary care patients’ assessments with regard to personal continuity of care.AimTo ascertain whether patient-reported longitudinal personal continuity of care is related to patient characteristics and their consultation experiences, and how this had changed over the study period.Design and settingA 15-year follow-up questionnaire survey that took place at Tampere University Hospital catchment area, Finland.MethodThe survey was conducted among patients attending health centres in the Tampere University Hospital catchment area from 1998 until 2013. From a sample of 363 464 patients, a total of 157 549 responded. The responses of patients who had visited a doctor during the survey weeks (n = 97 468) were analysed. Continuity of care was assessed by asking the question: ‘When visiting the health centre, do you usually see the same doctor?’; patients could answer ‘yes’ or ‘no’.ResultsApproximately half of the responders had met the same doctor when visiting the healthcare centre. Personal continuity of care decreased by 15 percentage points (from 66% to 51%) during the study years. The sense of continuity was linked to several patients’ experiences of the consultation. The most prominent factor contributing to the sense of continuity of care was having a doctor who was specifically appointed (odds ratio 7.28, 95% confidence interval = 6.65 to 7.96).ConclusionContinuity of care was proven to enhance the experienced quality of primary care. Patients felt that continuity of care was best realised when they could consult a doctor who had been specifically appointed to them. Despite efforts of the authorities, over the past 15 years patient-reported continuity of care has declined in Finland.

Continuity of nursing care in Finnish primary health care settings: A 15-year follow-up

“…[19] In our previous study the most prominent factor contributing to a sense of continuity of care is having a doctor specifically appointed to the patient. [20] In light of this finding and also previous literature on continuity of care, it is relevant to explore the contribution of consultation with the same nurse. Patients' experiences are essential in arranging services based on their needs and integrating them as well as possible for multiprofessional, cost-effective practices.…”

“…[20] Such patients could profit from a care manager, who, together with a team of professionals, would integrate and coordinate their care, and also empower them to promote their own care. For these patients the possibility of choosing their own doctor and nurse would be ideal.…”

“…[19] Although Finnish health care centres vary considerably in actual size and target population, [18,19] the focus has been on systematically developing the quality of care, increasing its resources and integration, and emphasizing patients' role in their own care. [19,20] 1.3 The aim of the study Prior to this present paper, there have been no systematic studies assessing longitudinal interpersonal continuity of care by primary health care nurses in Finland. International evidence is also lacking.…”

“…The questions were based on international studies [19] and adapted to the special characteristics of Finnish primary health care. [20] The questionnaire was piloted in the Pirkanmaa area in 1998, at which time 9,276 patients responded. In 1999, the study was extended to primary health care centres located in the catchment area of Tampere University Hospital.…”

“…[21] The challenges involved in studies using a questionnaire survey are obvious. [20][21][22][23][24] Reliance on reception staff distributing questionnaires is flawed as a means of systematic inquiry and involves a notable sampling bias. Since, however, the same flaws apply all data obtained, it is reasonable to conclude that comparison over time is still robust.…”