Variations in older people’s use of general practitioner consultations and the relationship with mortality rate in Vantaa, Finland in 2003–2014

Abstract

Objective: It is generally expected that the growth of the older population will lead to an increase in the use of health care services. The aim was to examine the changes in the number of visits made to general practitioners (GP) by the older age groups, and whether such changes were associated with changes in mortality rates. Design and setting: A register-based observational study in a Finnish city where a significant increase in the older population took place from 2003 to 2014. The number of GP visits made by the older population was calculated, the visits per person per year in two-year series, together with respective mortality rates. Subjects: The study population consisted of inhabitants aged 65 years and older (65þ) in Vantaa that visited a GP in primary health care. Main outcome measures: The number of GP visits per person per year in the whole older population during the study years. Results: In 2009-2010, there was a sudden drop in GP visits per person in the younger (65-74 years) age groups examined. In the population aged 85þ, use of GP visits remained at a fairly constant level. The mortality rate decreased until the year 2008. After that, the positive trend ended and the mortality rate plateaued. Conclusions: Simultaneously with the decline in GP visits per person in the older population, the mortality rate leveled off from its positive trend in 2009-2010. Factors identified being associated with the number of GP consultations were organizational changes in primary health care, economic recession causing retrenchment, and even vaccinations during the swine flu epidemic. KEY POINTS Along with an increasingly ageing population, concern over the supply of publicly funded health care has become more pronounced. The amount of GP visits of 65þ decreased in primary health care, especially in the youngest groups. However, in the oldest age groups (85þ), the use of GPs remained unchanged regardless of changes in service supply. As the rate of GP visits among the population of 65þ declined, the positive trend in the mortality rate ceased.

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

“…Further, previous Finnish studies have reported that the number of appointments per GP has generally decreased in PHC [14,37]. During the last decades, this decrease has not been evident in the oldest age cohorts [17]. There was no increase in the other studied types of consultations either.…”

“…It has been suggested that if PHC is unavailable, more urgent treatment-oriented sites of healthcare are forced to back-up its functions [29,30]. In line with this, when PHC started to have difficulties maintaining its normal non-urgent services during the last years of nGP [14,17], non-urgent scheduled appointments were compensated for by urgent ones, although appointments at the emergency department per se were not affected in the study population.…”

“…As the GP workforce decreased and the total number of appointments was reduced, patients had to substitute their non-urgent scheduled appointments with their nGP for urgent scheduled appointments with any GP, which led to poor continuity of care. Furthermore, it became challenging to employ GPs to work in the PHC centres [15] and, finally, the economic recession of 2008 reduced financial resources [17] in the municipalities. Therefore, in 2011, the municipality of Vantaa launched another model -the "restricted-list GP" (rLGP) model -to ensure access to GPs and continuity of care for older adults aged 75+ and those suffering from chronic diseases [15,18].…”

Development of the use of primary health care emergency departments after interventions aimed at decreasing overcrowding: a longitudinal follow-up study

“…However, in the studied age groups 20–64 and 65+ the mortality tended to decrease [ 18 ]. Only a slight plateauing of the decreasing monthly mortality was observed in the oldest age group (65+) after 2008, the year of the implementation of “reverse triage”, [ 5 ] but analogous plateauing was observed in the mortality of the whole Finnish 65+ age group in the period 2008–2014 [ 20 ]. Thus, no lethal safety hazards were found in this analysis.…”