Comparison of two GP service provider models in older adults: a register-based follow-up study

Abstract

BackgroundIn Finland,there have been various strategies attempting to provide access to general practitioners (GPs). The "restricted-list general practitioner model" (rLGP) was launched in primary healthcare (PHC) in the city of Vantaa after the "named general practitioner model" (nGP) failed to provide sufficient access to GPs. This was done to improve access to GP appointments for those most needing care.AimTo evaluate the impact of the transition from nGP to rLGP on access to non-urgent scheduled appointments amongpatients aged 75 years or older.Design and settingA register-based follow-up study in the public PHC in Vantaa, Finland. Patients aged 75 years or older who used PHC 2004-2018.MethodWe studied the number of non-urgent and urgent scheduled appointments, patient contacts, home visits, PHC emergency department appointments and cancelled appointments recorded sevenyears before and after the transition from nGP to rLGP in 2011 and adjusted to patient-years. Non-urgent appointments were booked to one’s own nGP or rLGP in public PHC, whereas urgent appointments could be to any GP.ResultsThe number of non-urgent scheduled appointments to GPs decreased by 50% during the time of nGP, before launching the rLGP.Simultaneously, the number of urgent scheduled appointments more than tripled. The number of both started to plateau a year before the rLGP was launched. The number of both non-urgent and urgent scheduled appointments remained mainly at that level after rLGP was implemented.ConclusionThe rLGP model was unsuccessful to improve access to non-urgent scheduled appointments to GPs.