Effect of establishing a primary health care centre on the utilization of primary health care and other out-patient care in a Swedish urban area.

The aim of the study was to describe the changes in the way the population in the catchment area of one parish in Stockholm utilized the available out-patient services after primary health care in the area had been expanded by establishing the Matteus health centre. Primary health care resources in the district expanded from two district physicians, one assistant physician and four district nurses before the project started to 7.5 district physicians, 15 district nurses plus other assistant personnel. A controlled longitudinal before and after design was used over a period of four years, 1978-81. The results showed that the population in the study district doubled the number of visits to district physicians and nurses after establishment of the health centre. Visits to hospital out-patient clinics were reduced by 26% (40% reduction for emergency visits and 16% for polyclinic appointments). Visits to nonpublic employed physicians (private, occupational and school health physicians) decreased by 31% after establishment of the Matteus health centre. Furthermore the population decreased their utilization of the Stockholm emergency car service by 28%. These results support the workload reduction hypothesis--that an expansion of primary health care leads to a reduction of the workload of hospitals, and not an overall increase in utilization of health care.