# Frequent attenders in primary health care in Finland: use of primary care services and patient characteristics

## TL;DR

This study examines frequent users of primary health care in Finland, finding they are mostly older women with chronic conditions and rely heavily on nursing services.

## Contribution

The study identifies persistent patterns of frequent attendance and highlights the significant role of nursing care in managing these patients.

## Key findings

- Frequent attenders account for nearly half of all primary health care visits despite being only 15.9% of patients.
- Persistent frequent attenders have significantly more nurse visits compared to non-FAs, with nurses handling two-thirds of their contacts.
- Chronic skin wounds and multimorbidity are strongly associated with frequent attendance.

## Abstract

This study investigated frequent attenders (FAs) in primary health care in Helsinki, Finland, focusing on their service use, sociodemographic characteristics (sex, age, and language), and diagnostic profiles using registry data.

Register-based cohort data were drawn from administrative records in primary, specialised, and oral health care of the City of Helsinki and Helsinki University Hospital (2015–2019; n = 297 845). FAs were defined as the top decile of annual primary health care users. Physician and nurse face-to-face visits were included. Patients were categorised by how many years (1–5) they met FA criteria. Statistical analyses were performed using the χ2 test or, when appropriate, Poisson regression with robust variance estimation to estimate prevalence ratios (PRs).

Frequent attenders had more than seven annual face-to-face primary health care visits. Although representing only 15.9% of patients, FAs accounted for nearly half of all health care visits. FAs were more often women, aged over 65, and native Finnish speakers. Chronic diseases and multimorbidity were more prevalent among FAs. Chronic skin wounds were strongly associated with frequent attendance. As attendance persisted, visit distribution shifted: physician visits increased from 0.7 among non-FAs to 6.4 among 5-year FAs, while nurse visits rose from 0.6 to 11.4 annually, comprising nearly two-thirds of contacts among persistent FAs.

FAs represent a small but high-need group in primary health care. Their service use is driven not only by physicians but disproportionately by nurses, highlighting the importance of including nursing care in research and resource planning.