Perhoniemi Riku, Blomgren Jenni
The Social Insurance Institution of Finland, P.O. Box 450, 00056 KELA, Helsinki, Finland.
BMC Public Health. 2021 May 6;21(1):870. doi: 10.1186/s12889-021-10866-x.
Frequent attenders (FAs) impose a significant burden on service capacity and public health funding. Although the characteristics of the group and their risk for sickness absences (SA) have been studied, an understanding of FAs in different health care schemes is lacking. The aim of the study was to investigate FAs and their SA risk in the working-age population in public care, occupational health services (OHS) and private care schemes. The average number of SA days was also examined by diagnostic group.
Register data on the use of outpatient health care, sickness allowance spells and background characteristics (2015-2018) for 25-64 year old residents of the city of Oulu, Finland, (n = 91,737) were used. Subjects were categorized into non-attenders, non-frequent attenders and FAs (top decile of attenders) both for all outpatient health care and specifically for each care scheme in 2016. The number of sickness absence days was measured yearly in 2016, 2017 and 2018. The data were analyzed with descriptive methods and negative binomial regression models.
FAs consumed 31 to 44% of all visits depending on scheme in 2016. Frequent attendance was common among low socioeconomic groups in the public scheme, among lower non-manual employees and manual workers in OHS, and among entrepreneurs in the private scheme. FAs had a higher average number of SA days than others in each scheme, although group differences decreased from 2016 to 2017 and 2018. In public care, the adjusted effect of frequent attendance was strong especially for SA due to mental disorders (adjusted incidence rate ratio [IRR] for FAs 13.40), and in OHS for SA due to musculoskeletal disorders (adjusted IRR for FAs 8.68).
In each outpatient health care scheme, frequent attenders pose a great challenge both by consuming services and through their increased risk of disability. FAs in different schemes have partially different characteristics and risks. Common patient registers covering various service schemes would enable an identification of FAs visiting multiple schemes and services. Better coordinated services are needed for public care FAs in particular.
频繁就诊者给服务能力和公共卫生资金带来了沉重负担。尽管已对该群体的特征及其病假风险进行了研究，但对于不同医疗保健计划中的频繁就诊者仍缺乏了解。本研究的目的是调查公共医疗、职业健康服务（OHS）和私人医疗计划中工作年龄人群的频繁就诊者及其病假风险。还按诊断组检查了平均病假天数。
使用了芬兰奥卢市25至64岁居民（n = 91,737）2015 - 2018年门诊医疗使用情况、病假津贴期及背景特征的登记数据。在2016年，将所有门诊医疗的受试者以及每个医疗计划中的受试者分为非就诊者、非频繁就诊者和频繁就诊者（就诊者的最高十分位数）。在2016年、2017年和2018年每年测量病假天数。使用描述性方法和负二项回归模型对数据进行分析。
2016年，根据计划不同，频繁就诊者占所有就诊次数的31%至44%。在公共计划中的低社会经济群体、OHS中的较低非体力劳动者和体力劳动者以及私人计划中的企业家中，频繁就诊很常见。尽管从2016年到2017年和2018年组间差异有所减小，但每个计划中频繁就诊者的平均病假天数均高于其他人群。在公共医疗中，频繁就诊的调整效应对于因精神障碍导致的病假尤为显著（频繁就诊者的调整发病率比[IRR]为13.40），而在OHS中对于因肌肉骨骼疾病导致的病假（频繁就诊者的调整IRR为8.68）。
在每个门诊医疗计划中，频繁就诊者在消耗服务以及残疾风险增加方面都构成了巨大挑战。不同计划中的频繁就诊者具有部分不同的特征和风险。涵盖各种服务计划的通用患者登记册将有助于识别就诊于多个计划和服务的频繁就诊者。尤其需要为公共医疗中的频繁就诊者提供更好协调的服务。
