Occasional and persistent frequent attenders and sickness absences in occupational health primary care: a longitudinal study in Finland

Abstract

ObjectivesFrequent attenders (FAs) create a substantial portion of primary care workload but little is known about FAs’ sickness absences. The aim of the study is to investigate how occasional and persistent frequent attendance is associated with sickness absences among the working population in occupational health (OH) primary care.Setting and participantsThis is a longitudinal study using medical record data (2014–2016) from an OH care provider in Finland. In total, 59 676 patients were included and categorised into occasional and persistent FAs or non-FAs. Sick-leave episodes and their lengths were collected along with associated diagnostic codes. Logistic regression was used to analyse associations between FA status and sick leaves of different lengths (1–3, 4–14 and ≥15 days).ResultsBoth occasional and persistent FA had more and longer duration of sick leave than non-FA through the study years. Persistent FAs had consistently high absence rates. Occasional FAs had elevated absence rates even 2 years after their frequent attendance period. Persistent FAs (OR=11 95% CI 7.54 to 16.06 in 2016) and occasional FAs (OR=2.95 95% CI 2.50 to 3.49 in 2016) were associated with long (≥15 days) sickness absence when compared with non-FAs. Both groups of FAs had an increased risk of long-term sick leaves indicating a risk of disability pension.ConclusionBoth occasional and persistent FAs should be identified in primary care units caring for working-age patients. As frequent attendance is associated with long sickness absences and possibly disability pensions, rehabilitation should be directed at this group to prevent work disability.

Socioeconomic Differences in Occupational Health Service Utilization and Sickness Absence Due to Mental Disorders: A Register-Based Retrospective Cohort Study

“…There were differences between the age groups in how well different measures, i.e., OHS patterns, predicted SA. In line with previous studies [6,7], we showed that the employees with a risk of subsequent SA might be identified by their frequent OHS utilization. The present study further showed that frequent attendance may be captured by different utilization pattern categories: the traditional frequent attendance measure as the cumulative visits within a year, but also by the clustered patterns of OHS visits.…”

“…Thus, OHS is one potential site for promoting effective workplace interventions for preventing SA due to mental disorders. The utilization of health care services is a known contributor to inequalities in health [4,5], and previous study from Finland found that frequent attendance at OHS is associated with subsequent SA [6], which in turn may lead to disability pension [7][8][9]. A gap in knowledge remains about the role of OHS utilization in the processes leading to health inequalities.…”

“…A gap in knowledge remains about the role of OHS utilization in the processes leading to health inequalities. The socioeconomic distribution of frequent OHS attendance is not known [6] and this knowledge is needed to provide information for planning preventive actions through targeted interventions [10]. Frequent OHS visits may also be associated with socioeconomically differentiated levels of SA [11][12][13] and also existing sickness burden, as previous studies have shown recurrent nature of both all-cause and mental ill-health related SA [14,15].…”

Improved recording of work relatedness during patient consultations in occupational primary health care: a cluster randomized controlled trial using routine data

“…Our linked study on frequent attenders in occupational health services similarly identified women as at risk of frequent use of services [23], where particularly women from the service industry and public administration were at risk [23]. We also found that frequent attenders of OHS primary care are also at increased risk of sickness absences after their consultation frequency has diminished [24]. This supports the lack of impact on sickness absences, when no workplace intervention was included.…”

Improved recording of work relatedness during patient consultations in occupational primary health care: A cluster randomized controlled trial using routine data

“…Our linked study on frequent attenders in occupational health services similarly identified women as at risk of frequent use of services more than men (22), a risk that was higher for women from the service industry and public administration (22). We also found that frequent attenders of OHS primary care are at an increased risk of sickness absences also after their consultation frequency has diminished (23). This supports the the lack of impact on sickness absences, when no workplace intervention was included.…”