Continuity of care among frequent attenders in public primary care in Finland

Background

Continuity of care (COC) is associated with improved health outcomes, patient satisfaction and reduced healthcare use, making it a key objective for efficient and equitable primary care systems. However, there is limited evidence on COC among frequent attenders (FAs), who are a small group of patients accounting for a disproportionate share of service use. Furthermore, COC has largely been examined in relation to physicians, although nurses play an increasingly important role in primary care. The aim of this study was to examine COC in physician and nurse visits among FAs in public primary health care.

Methods

A register-based cohort of adults (≥18 years) with ≥3 face-to-face physician or nurse visits in public primary care in Helsinki, Finland, 2015–2019 (n = 203,555) was analysed. FAs were defined as the top decile of annual users and categorised by the number of years (1–5) they met this criterion. Others were classified as non-FAs. COC was measured using the Continuity of Care Index (COCI, range 0–1).

Results

Healthcare use increased substantially with FA duration, especially for nurse visits. Five-year FAs had a mean of 32.7 physician and 55.9 nurse visits during the study period, compared with 5.8 and 4.8 visits among non-FAs, respectively. Overall, most patients had low continuity (COCI≤0.32). Physician continuity was consistently higher than nurse continuity regardless of FA duration. High continuity of care was less common among FAs than non-FAs in both physician and nurse visits, although 5-year FAs showed slightly higher nurse continuity.

Conclusions

Continuity of care among frequent attenders is low, particularly in nurse visits, despite high use of nurse-led care. As nurses play an increasingly central role in primary care and physician continuity is known to be beneficial, continuity in nurse-led care warrants greater attention in research and service development alongside physician continuity.

Key messages

• Continuity of care improves patient outcomes, but high continuity is generally less common among frequent attenders than other patients in public primary care, for both physician and nurse visits.

• Frequent attenders rely heavily on nurse care. As nurses’ role expands, continuity in nurse-led care should be a focus of research and primary care development alongside physician continuity.