RESEARCH – October 2019

Main causes of using primary care services and distribution of work between family doctor and family nurse in 2017

Authors: Eva Anderson, Merike Rätsep, Liisi Panov, Katre Väärsi, Viktoria Kirpu, Diana Sokurova, Natalja Eigo

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Background. The physicians and nurses of primary care are in most cases the first contact for a person with a health concern. Because of the generally heavy workload in primary health care, but sometimes also because of family doctor`s unreasonable referrals, patients present to a specialised doctor.

Aim. The aim of the study was to find out, by diagnoses, the main causes why primary health care was provided and to analyse the division of labour between family doctor and family nurse. The study was initiated by the Estonian Society of Family Doctors.

Methodology. The cross-sectional study was based on the Estonian Health Insurance Fund`s database of medical care invoices 2017. The frequency distribution of visits was examined according to the main reasons for the visits. Methods of descriptive statistics were used to compare the averages of different groups.
Results. In 2017, primary health care services were used by over a million people, i.e. 82% of women and 72% of men residing in Estonia. The family doctor was most often visited because of concerns related to infants (aged 0–4 years),on average nine times a year. This was followed by elderly patients (65-year-old and older), on average eight times a year. Young people (15–24-year-old) presented to the family doctor the least, on average four times a year. Out of 6.5 million visits, 60% were made by 45-year-old and older patients. The share of 65 year-old and older women acounte for 21% of all visits to the family doctor. Visits to family doctors were more frequently caused by diseases of the respiratory (17%) or circulatory system (17%), other health-related issues (17%), and  musculoskeletal and connective tissue disorders (12%). Out of all visits, 70% were outpatient visits, 29% were phone consultations and 1% were e-mail consultations. Three-quarters of the patients were seen by the family doctor and one fourth were seen by the family nurse. The family doctor was mostly involved in cases related to the diseases of the respiratory and circulatory systems, while the family nurse dealt with other health-related issues (e.g. health certificates) and with diseases of the circulatory system.

Conclusion. More frequent reasons for visiting the family doctor were equally divided between three main diagnoses, including consulting for or treatment of acute and chronic illnesses as well as various prophylactic activities. Visits to the family doctor due to chronic diseases (e.g. diseases of the circulatory system) made up a large share of family doctor`s care, but the quality of the visits requires further analysis. As there are inconsistencies in encoding the reasons for visits, especially those made due to other health-related issues, clearer rules for coding are needed.