Skip to main content

Main menu

  • HOME
  • LATEST ARTICLES
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • RESOURCES
    • About BJGP Open
    • BJGP Open Accessibility Statement
    • Editorial Board
    • Editorial Fellowships
    • Audio Abstracts
    • eLetters
    • Alerts
    • BJGP Life
    • Research into Publication Science
    • Advertising
    • Contact
  • SPECIAL ISSUES
    • Artificial Intelligence in Primary Care: call for articles
    • Social Care Integration with Primary Care: call for articles
    • Special issue: Telehealth
    • Special issue: Race and Racism in Primary Care
    • Special issue: COVID-19 and Primary Care
    • Past research calls
    • Top 10 Research Articles of the Year
  • BJGP CONFERENCE →
  • RCGP
    • British Journal of General Practice
    • BJGP for RCGP members
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers

User menu

  • Alerts

Search

  • Advanced search
Intended for Healthcare Professionals
BJGP Open
  • RCGP
    • British Journal of General Practice
    • BJGP for RCGP members
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers
  • Subscriptions
  • Alerts
  • Log in
  • Follow BJGP Open on Instagram
  • Visit bjgp open on Bluesky
  • Blog
Intended for Healthcare Professionals
BJGP Open

Advanced Search

  • HOME
  • LATEST ARTICLES
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • RESOURCES
    • About BJGP Open
    • BJGP Open Accessibility Statement
    • Editorial Board
    • Editorial Fellowships
    • Audio Abstracts
    • eLetters
    • Alerts
    • BJGP Life
    • Research into Publication Science
    • Advertising
    • Contact
  • SPECIAL ISSUES
    • Artificial Intelligence in Primary Care: call for articles
    • Social Care Integration with Primary Care: call for articles
    • Special issue: Telehealth
    • Special issue: Race and Racism in Primary Care
    • Special issue: COVID-19 and Primary Care
    • Past research calls
    • Top 10 Research Articles of the Year
  • BJGP CONFERENCE →
Research

Comparison of two GP service provider models in older adults: a register-based follow-up study

Aina Enckell, Merja K Laine, Hannu Kautiainen, Mika T Lehto, Kaisu H Pitkälä, Ossi Rahkonen, Hanna-Maria Roitto and Timo Kauppila
BJGP Open 2023; 7 (3): BJGPO.2022.0101. DOI: https://doi.org/10.3399/BJGPO.2022.0101
Aina Enckell
1 Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
2 City of Espoo, Welfare and Health Sector, Espoo, Finland
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Aina Enckell
Merja K Laine
1 Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
3 Folkhälsan Research Centre, Helsinki, Finland
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Merja K Laine
  • For correspondence: merja.k.laine@helsinki.fi
Hannu Kautiainen
1 Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
3 Folkhälsan Research Centre, Helsinki, Finland
4 Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Hannu Kautiainen
Mika T Lehto
1 Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
5 City of Vantaa, Vantaa, Finland
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Mika T Lehto
Kaisu H Pitkälä
1 Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Kaisu H Pitkälä
Ossi Rahkonen
6 Department of Public Health, University of Helsinki, Helsinki, Finland
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Ossi Rahkonen
Hanna-Maria Roitto
7 Department of Neurosciences, University of Helsinki, Helsinki, Finland
8 Department of Geriatrics, Helsinki University Hospital, Helsinki, Finland
9 Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Hanna-Maria Roitto
Timo Kauppila
1 Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Timo Kauppila
  • Article
  • Figures & Data
  • Info
  • eLetters
  • PDF
Loading

Abstract

Background In Finland, there have been various strategies attempting to provide access to GPs. The 'restricted-List General Practitioner model' (rLGP) was launched in primary health care (PHC) in the city of Vantaa after the 'named General Practitioner model' (nGP) failed to provide sufficient access to GPs. This was done to improve access to GP appointments for those most needing care.

Aim To evaluate the impact of the transition from nGP to rLGP on access to non-urgent scheduled appointments among patients aged ≥75 years.

Design & setting A register-based follow-up study in public PHC in Vantaa, Finland.

Method The study focused on patients aged ≥75 years who used PHC from 2004–2008. It looked at the number of non-urgent and urgent scheduled appointments, patient contacts, home visits, PHC emergency department appointments, and cancelled appointments, which were recorded 7 years before and after the transition from nGP to rLGP in 2011 and adjusted to patient-years. Non-urgent appointments were booked to the patient’s own nGP or rLGP in public PHC, whereas urgent appointments could be to any GP.

Results The number of non-urgent scheduled appointments to GPs was halved during the time of nGP, before launching the rLGP. Simultaneously, the number of urgent scheduled appointments more than tripled. The number of both started to plateau a year before the rLGP was launched. The number of both non-urgent and urgent scheduled appointments remained mainly at that level after rLGP was implemented.

Conclusion The rLGP model was unsuccessful in improving access to non-urgent scheduled appointments to GPs.

  • continuity of patient care
  • follow-up
  • general practitioners
  • health services accessibility
  • patient appointments
  • primary health care

How this fits in

A well-functioning service provider model could provide a good basis for adequate access and continuity of care in PHC. Two models were compared that were used in public PHC centres in the city of Vantaa, Finland. It was found that the transition from a named GP model to a restricted-list model did not improve access to non-urgent appointments to the GP.

Introduction

Adequate access and continuity of care are considered essential for good quality PHC.1,2 Access to PHC is important when attempting to improve the health and wellbeing of the population, and to further reduce mortality rates.3–5

In Finland, there have been various strategies in PHC that have attempted to improve access to GPs. PHC services are mainly organised by municipal PHC centres that are publicly funded, and the GPs are, for the most part, employed and directly governed by the municipal health administration.6 The size of PHC centres and the population assigned to them vary considerably.

Employed patients may choose to consult a GP either in PHC or in occupational health,7 as occupational health services — expenses largely covered by employing companies — also play a notable role in Finnish health care by providing primary care to the employed population. Occupational health services end when the employee retires, which in Finland is at an age of approximately 65 years. Thus, PHC is the main provider of health care for older adults if they do not choose a private physician, for which they must pay extra.8

In the 1990s, the city of Vantaa organised PHC based on the nGP (a named GP model).9 The idea of the nGP was that the GP had a geographic area with a population of around 2000 people whose health they were responsible for.9 GPs took care of all primary care health problems of their population, including, to some extent, preventive medicine. GPs during this time experienced high workloads and professional demands, and poor possibilities for colleague consultation.10,11 Based on a Finnish study, patients initially liked the nGP system because of the continuity of care,12 but the access to care gradually worsened over the years, as the named GPs in Vantaa started to transfer from PHC centres to other workplaces owing to high workload.13–16 As the GP workforce decreased and the total number of appointments was reduced, patients had to substitute their non-urgent scheduled appointments with their nGP for urgent scheduled appointments with any GP, which led to poor continuity of care. Furthermore, it became challenging to employ GPs to work in the PHC centres15 and, finally, the economic recession of 2008 reduced financial resources17 in the municipalities. Therefore, in 2011, the municipality of Vantaa launched another model — the rLGP (a restricted-list GP model) — to ensure access to GPs and continuity of care for older adults aged ≥75 years and those suffering from chronic diseases.15,18 This rLGP was adapted from PHC in neighbouring countries, where patients were able to enlist to a GP if there were open positions.19,20 The Norwegian enlistment system was reported to be associated with good patient and GP satisfaction, adequate access to GPs, relatively well-functioning communication between patients and GPs, and good continuity of care in PHC.19,21–24 Furthermore, this kind of enlistment was reported to be associated with decreased use of emergency services.25 Thus, the theory was that the new rLGP model, adapted from neighbouring countries, would ensure access to care for the patients who needed it the most, by attracting a GP workforce and by allocating non-urgent appointments for the listed patients.18

To be eligible for enlistment to the rLGP in Vantaa, the patient had to meet one of the following criteria: to be aged ≥75 years; to have had ≥7 appointments to a GP during the previous 2 calendar years; or have a certain chronic diagnosis that requires constant management (for example, diabetes or heart disease). Additionally, a patient could also be enlisted if a healthcare professional judged that they would benefit from it. Patients, other than the above mentioned, were not assigned to any particular GP and were instead taken care of by the GP teams with collective responsibility.

In the city of Vantaa, the transition from the original nGP to the novel rLGP occurred in 2011. The aim of the study was to evaluate the impact of the transition from nGP to rLGP on access to non-urgent scheduled appointments among patients aged ≥75 years.

Method

This register-based follow-up study was conducted in the city of Vantaa, Finland. With a population of 239 206 (as of 31 December 2021), Vantaa is the fourth most populated city in Finland, located in the Helsinki metropolitan area. Of the whole population, 50.2% were men, 15.7% were aged ≥65 years, and 23.4% had a foreign background. Of the older population (≥75 years), 40% were men.26

Data for the Vantaa PHC centres were obtained from the Graphic Finstar electronic health record system. This electronic health record system enabled the data to be analysed at the individual patient and GP levels. Data consisted of all face-to-face appointments and patient contacts during the study period between 1 September 2004 and 31 August 2018. Consultations were used as a proxy measure of access. Data were collected from all of the seven public PHC centres in Vantaa. Data from the private sector were not available.

The main measures were the number of various types of GP consultations documented 7 years before and after the transition from nGP to rLGP. The transition from nGP to rLGP took place on 1 September 2011. The following were calculated: the number of face-to-face scheduled non-urgent appointments and urgent appointments; paper and phone consultations; home visits; PHC emergency department appointments; and cancelled appointments.

A non-urgent appointment with sufficient time was a consultation performed by the named or list GP. This appointment was long enough to enable comprehensive care of chronic diseases. An urgent appointment was a short consultation by any GP in the health centre. A paper consultation was a note the GP writes in the electronic health record system without seeing the patient or talking to them on the phone; for example, interpretation of laboratory results containing care instructions, or statements.

The appointments were booked preferably to the named or list GP by phone or at the PHC centre by a healthcare worker, and were the same at all seven PHC centres during the study period. If there were any technical problems with the electronic health record system, the GPs wrote and added the appointment records afterwards. The number of various types of consultations were adjusted to the number of individuals aged ≥75 years in the population using the service. As a secondary measurement, the amount of GP workforce, expressed as person-years, was adjusted to the number of the same population.

Statistical analyses

Incidence rates of consultations were calculated across 14 calendar-year periods (2004−2018), 7 years before and after intervention. Consultations of GPs were reported as appointment rates per 1000 person-years with 95% confidence intervals (CIs) based on a Poisson distribution. The Poisson regression models were tested using the goodness-of-fit test, and the assumptions of overdispersion in models were tested using the Lagrange multiplier test. A possible non-linear relationship between the number of contacts and the years was assessed by using a 4-knot-restricted cubic spline Poisson regression model. Stata (version 17.0) statistical package was used for the analysis.

Results

Altogether, 1 392 266 GP consultations from 23 409 different patients were recorded. Of the patients, 39.1% were men. The mean age at the time of appointments was 81 years (standard deviation: 5 years). Data consisted of 211 184 non-urgent and 149 978 urgent scheduled appointments to GPs’ offices, 9724 home visits performed by the GPs, 531 750 paper consultations, 156 149 phone consultations, 281 950 prescription renewals, 49 424 visits to the PHC emergency department, and 2107 cancelled appointments to the GPs.

The number of all appointments decreased during the nGP (P<0.001); they had, however, already plateaued before the transition to rLGP (Figure 1a). The number of non-urgent scheduled appointments to the GP plateaued following the same pattern (Figure 1b) (P<0.001). The increase in the number of urgent scheduled consultations occurred before rLGP was implemented (Figure 1b).

Figure 1.
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 1. (A) Numbers of all face-to-face appointments of patients aged ≥75 years to GPs per 1000 person-years. The line shows the mean, and the dashed area the 95% confidence interval. (B) Numbers of non-urgent scheduled and urgent scheduled appointments to GPs per 1000 person-years. The appointments were derived from 4-knot-restricted cubic spline regression models. Grey areas represent 95% confidence intervals. pyrs = person-years; 0 = timepoint of model change.

Implementing rLGP had no impact on home visits performed by the GPs (data not shown) or appointments at the PHC emergency department (data not shown). Implementing rLGP did not alter the number of paper or phone consultations or cancelled appointments to the GPs (data not shown). The work resources of GPs adjusted to the studied population decreased during the rLGP period (Figure 2) (P<0.001).

Figure 2.
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 2. The top figure illustrates the numbers of all face-to-face appointments to GPs per 1000 person-years and the bottom figure the respective amount of GP workforce expressed as person-years adjusted to the number of patients aged ≥75 years. The appointments were derived from 4-knot-restricted cubic spline regression models. Grey areas represent 95% confidence intervals. pyrs = person-years; 0 = timepoint of model change.

Discussion

Summary

The transition from nGP to rLGP did not significantly alter access to PHC services in patients aged ≥75 years. The workforce of GPs adjusted to the studied population decreased, especially at the end of the follow-up time. Although the study population had a named GP in both models, the transition to rLGP failed to improve access to non-urgent appointments.

Strengths and limitations

The study has various strengths. The present data were very large and precise, and provided lots of information about the quantitative changes from the administrative point of view. Of the patients, 39.1% were men, so in terms of sex, the studied population represented the older adults in Vantaa well. As women tend to live longer, they are usually over-represented in studies of this age group.26 The data allowed the authors to study various types of appointments to the GPs. The follow-up period was relatively long; therefore, it provided the possibility to make reliable conclusions about the trends in the studied parameters. Although similar models have been applied in various cities and municipalities in Finland, comparative research between the models has not been done before. It is important to assess the effects of any changes in PHC and evaluate the consequences.

As a limitation, the present study does not provide information about the qualitative aspects of these models from the healthcare professionals’ or patients’ perspectives. Data on whether urgent appointments were appropriate would have helped to determine whether access to non-urgent appointments was inadequate and, therefore, led to an increase in inappropriate acute appointments being booked. A consultation is an administrative unit that allows the resources used to be counted, but it does not provide information about the output of the studied PHC, such as endpoint-level information about the impact on health, diseases treated, or healthcare professionals’ permanence.27,28 The time of the appointment captured the amount of time that was booked, not the actual time used. Thus, it is not known if the time spent with the patient altered pre- and post-intervention. Further, it is not known how often the patients saw the same GPs during the non-urgent or urgent appointments. Lastly, the study had no reliable data on nurse appointments before the year 2008. This information would have been necessary to evaluate whether there was a shift of workload from GPs to nurses.

Comparison with existing literature

In the beginning of the follow-up in 2004–2006 when the nGP was still functioning well, the level of non-urgent scheduled appointments was relatively high and urgent appointments low. After those years, it became challenging to respond to the population’s health needs, and there was a shift from non-urgent appointments towards urgent appointments. It has been suggested that if PHC is unavailable, more urgent treatment-oriented sites of health care are forced to back-up its functions.29,30 In line with this, when PHC started to have difficulties maintaining its normal non-urgent services during the last years of nGP,14,17 non-urgent scheduled appointments were compensated for by urgent ones, although appointments at the emergency department per se were not affected in the study population.

Changing the nGP to rLGP did not increase the number of non-urgent appointments to GPs in the studied population aged ≥75 years, as had been expected based on the positive experiences from rLGP-like models elsewhere.19,21–32,31,32 It must, however, be pointed out that although the Norwegian list system acted as an example for the rLGP, there were also differences: in Norway the size of a list was 900–1200 patients, and there were only a few unlisted patients to take care of.22 In the present study, the size of a list was 400–500 patients who fulfilled the previously mentioned criteria and, in addition to this, the GPs had appointments with unlisted patients and urgent appointments with all patients, as well as preventive medicine. Therefore, the results are not directly comparable with those yielded in Norway.19,21–25 Older patients tend to use PHC because they have more chronic diseases and require more medical attention than younger patients.33 According to previous studies, short urgent appointments are not likely to be enough for older adults with various medical concerns.34–36 Thus, non-urgent scheduled appointments are more likely to ensure good medical praxis in this patient group.

The poor availability of GPs may be one of the reasons for the decrease in the input to care in the past 4 years of the follow-up, as resources per patient-years decreased in the studied age cohort. Thus, organisational changes did not overcome the lack of resources in PHC. The decrease in workforce did not lead to increased cancellations of non-urgent GP appointments. Further, previous Finnish studies have reported that the number of appointments per GP has generally decreased in PHC.14,37 During the past decades, this decrease has not been evident in the oldest-age cohorts.17 There was no increase in the other studied types of consultations either. Phone consultations have been suggested to replace face-to-face appointments to GPs,38 but no such increasing trend was seen in their use in the study cohort during these years. Although GP home visits might be ideal for treating older patients,39 whose treatment was expected to be improved with rLGP, no increasing trend was seen in these services either. The amount of home visits has traditionally been small in Finland because they are difficult and expensive to arrange. Additionally, this study did not observe that older patients were excessively redirected to the PHC emergency department, although this resource has often been suggested as a backup for office-hour primary care.40

Implications for practice

In older adults, rLGP was unsuccessful in the attempt to improve access to non-urgent scheduled appointment to GPs, which are thought to create the basis for comprehensive care.

Notes

Funding

This work was supported by the Hospital District of Helsinki and Uusimaa (VTR and ERVA).

Data availability

Data are not available. The ethical board did not allow giving data outside the researchers because they contain personal information about patients and physicians.

Ethical approval

The register keeper (the health authorities of Vantaa, VD/4713/13.00.00/2019) and the ethical board of the Medical Faculty of the University of Helsinki (nro 4/2019) granted permission to carry out the study.

Provenance

Freely submitted; externally peer reviewed.

Data

Data are not available. The ethical board did not allow the sharing of data outside the research group because they contain personal information about patients and physicians.

Acknowledgements

Competing interests

The authors declare that no competing interests exist.

  • Received July 3, 2022.
  • Revision received November 13, 2022.
  • Accepted February 23, 2023.
  • Copyright © 2023, The Authors

This article is Open Access: CC BY license (https://creativecommons.org/licenses/by/4.0/)

References

  1. 1.↵
    1. Wolinsky FD,
    2. Bentler SE,
    3. Liu L,
    4. et al.
    (2010) Continuity of care with a primary care physician and mortality in older adults. J Gerontol A Biol Sci Med Sci 65 (4):421–428, doi:10.1093/gerona/glp188, pmid:19995831.
    OpenUrlCrossRefPubMed
  2. 2.↵
    1. Nelson K,
    2. Sun H,
    3. Dolan E,
    4. et al.
    (2014) Elements of the patient-centered medical home associated with health outcomes among veterans: the role of primary care continuity, expanded access, and care coordination. J Ambul Care Manage 37 (4):331–338, doi:10.1097/JAC.0000000000000032, pmid:25180648.
    OpenUrlCrossRefPubMed
  3. 3.↵
    1. Basu S,
    2. Berkowitz SA,
    3. Phillips RL,
    4. et al.
    (2019) Association of primary care physician supply with population mortality in the United States, 2005–2015. JAMA Intern Med 179 (4):506–514, doi:10.1001/jamainternmed.2018.7624, pmid:30776056.
    OpenUrlCrossRefPubMed
  4. 4.
    1. Baker R,
    2. Honeyford K,
    3. Levene LS,
    4. et al.
    (2016) Population characteristics, mechanisms of primary care and premature mortality in England: a cross-sectional study. BMJ Open 6 (2), doi:10.1136/bmjopen-2015-009981, pmid:26868945. e009981.
    OpenUrlAbstract/FREE Full Text
  5. 5.↵
    1. Jerant A,
    2. Fenton JJ,
    3. Franks P
    (2012) Primary care attributes and mortality: a national person-level study. Ann Fam Med 10 (1):34–41, doi:10.1370/afm.1314, pmid:22230828.
    OpenUrlAbstract/FREE Full Text
  6. 6.↵
    1. Teperi J,
    2. Porter ME,
    3. Vuorenkoski L,
    4. Baron JF
    (2009) The Finnish health care system: a value-based perspective. Sitra Reports 82 (Sitra, Helsinki).
  7. 7.↵
    1. Kimanen A,
    2. Rautio M,
    3. Manninen P,
    4. et al.
    (2011) Primary care visits to occupational health physicians and nurses in Finland. Scand J Public Health 39 (5):525–532, doi:10.1177/1403494811399651, pmid:21321047.
    OpenUrlCrossRefPubMed
  8. 8.↵
    1. Blomgren J,
    2. Virta L
    (2014) [Income group differences in the probability of private doctor visits did not increase from 2006 to 2011] Tuloryhmien erot yksityislääkäripalvelujen käytössä eivät kasvaneet vuosina 2006-2011 (in Finnish, summary in English). Suomen Lääkärilehti 69 560–565.
    OpenUrl
  9. 9.↵
    1. Vohlonen I,
    2. Pekurinen M,
    3. Saltman RB
    (1989) Re-organizing primary medical care in Finland: the personal doctor program. Health Policy 13 (1):65–79, doi:10.1016/0168-8510(89)90111-5, pmid:10296156.
    OpenUrlCrossRefPubMed
  10. 10.↵
    1. Elovainio M,
    2. Salo P,
    3. Jokela M,
    4. Heponiemi T,
    5. et al.
    (2013) Psychosocial factors and well-being among Finnish GPs and specialists: a 10-year follow-up. Occup Environ Med 70 (4):246–251, doi:10.1136/oemed-2012-100996, pmid:23322916.
    OpenUrlAbstract/FREE Full Text
  11. 11.↵
    1. Kuusio H,
    2. Heponiemi T,
    3. Sinervo T
    (2010) Organizational commitment among general practitioners: a cross-sectional study of the role of psychosocial factors. Scand J Prim Health Care 28 (2):108–114, doi:10.3109/02813431003779647, pmid:20470018.
    OpenUrlCrossRefPubMed
  12. 12.↵
    1. Nakari M,
    2. Möttönen S
    (2000) [Does the population-based personal physician system increase customer satisfaction?] Lisääkö väestövastuinen omalääkärijärjestelmä asiakastyytyväisyyttä (in Finnish). Suomen Lääkärilehti 55 (21):2342–2346.
    OpenUrl
  13. 13.↵
    1. Heponiemi T,
    2. Kouvonen A,
    3. Aalto A-M,
    4. Elovainio M
    (2013) Psychosocial factors in GP work: the effects of taking a GP position or leaving GP work. Eur J Public Health 23 (3):361–366, doi:10.1093/eurpub/cks112, pmid:22930744.
    OpenUrlCrossRefPubMed
  14. 14.↵
    1. Lehto M,
    2. Mustonen K,
    3. Kantonen J,
    4. Raina M
    (2019) A primary care emergency service reduction did not increase office-hour service use: a longitudinal follow-up study. J Prim Care Community Health 10 doi:10.1177/2150132719865151, pmid:31354021. 2150132719865151.
    OpenUrlCrossRefPubMed
  15. 15.↵
    1. Mäntyselkä P,
    2. Halonen P,
    3. Vehviläinen A,
    4. et al.
    (2007) Access to and continuity of primary medical care of different providers as perceived by the Finnish population. Scand J Prim Health Care 25 (1):27–32, doi:10.1080/02813430601061106, pmid:17354156.
    OpenUrlCrossRefPubMed
  16. 16.↵
    1. Raivio R,
    2. Jääskeläinen J,
    3. Holmberg-Marttila D,
    4. Mattila KJ
    (2014) Decreasing trends in patient satisfaction, accessibility and continuity of care in Finnish primary health care-a 14-year follow-up questionnaire study. BMC Fam Pract 15 doi:10.1186/1471-2296-15-98, pmid:24885700. 98.
    OpenUrlCrossRefPubMed
  17. 17.↵
    1. Mustonen K,
    2. Kauppila T,
    3. Rahkonen O,
    4. et al.
    (2019) Variations in older people’s use of general practitioner consultations and the relationship with mortality rate in vantaa, Finland in 2003–2014. Scand J Prim Health Care 37 (4):452–458, doi:10.1080/02813432.2019.1684426, pmid:31709880.
    OpenUrlCrossRefPubMed
  18. 18.↵
    1. Seilo N,
    2. Koskela T,
    3. Jääskeläinen J,
    4. et al.
    (2010) The Pirkkalamodel: working with doctor-nurse teams and patient listing at a health centre. Suomen Lääkärilehti 65 2861–2866.
    OpenUrl
  19. 19.↵
    1. Fjermestad T,
    2. Paulsen B
    (2000) List patient system: straitjacket or a tool for developing general practice? General practitioners’ experiences from a pilot project in Norway. Scand J Prim Health Care 18 (1):21–24, doi:10.1080/02813430050202505, pmid:10811038.
    OpenUrlCrossRefPubMed
  20. 20.↵
    1. Lember M
    (2002) A policy of introducing a new contract and funding system of general practice in Estonia. Int J Health Plann Manage 17 (1):41–53, doi:10.1002/hpm.651, pmid:11963443.
    OpenUrlCrossRefPubMed
  21. 21.↵
    1. Lian OS,
    2. Wilsgaard T
    (2004) [Patient satisfaction with primary health care before and after the introduction of a list patient system] [aricle in Norwegian]. Tidsskr Nor Laegeforen 124 (5):655–658.
    OpenUrlPubMed
  22. 22.↵
    1. Eide TB,
    2. Straand J,
    3. Melbye H,
    4. et al.
    (2016) Patient experiences and the association with organizational factors in general practice: results from the Norwegian part of the International, multi-centre, cross-sectional QUALICOPC study. BMC Health Serv Res 16 (1):428, doi:10.1186/s12913-016-1684-z, pmid:27553244. 428.
    OpenUrlCrossRefPubMed
  23. 23.
    1. Carlsen B,
    2. Norheim OF
    (2003) Introduction of the patient-list system in general practice. Changes in Norwegian physicians’ perception of their gatekeeper role. Scand J Prim Health Care 21 (4):209–213, doi:10.1080/02813430310004155, pmid:14695070.
    OpenUrlCrossRefPubMed
  24. 24.↵
    1. Hetlevik Ø,
    2. Gjesdal S
    (2012) Personal continuity of care in Norwegian general practice: a national cross-sectional study. Scand J Prim Health Care 30 (4):214–221, doi:10.3109/02813432.2012.735554, pmid:23113798.
    OpenUrlCrossRefPubMed
  25. 25.↵
    1. Goth US,
    2. Hammer HL,
    3. Claussen B
    (2014) Utilization of Norway’s emergency wards: the second 5 years after the introduction of the patient list system. Int J Environ Res Public Health 11 (3):3375–3386, doi:10.3390/ijerph110303375, pmid:24662997.
    OpenUrlCrossRefPubMed
  26. 26.↵
    1. Parviainen E
    (2022) [Population of Vantaa 2021/2022] Vantaan vaesto 2021/2022 (in Finnish). accessed. https://www.vantaa.fi/sites/default/files/document/Vantaan_v%C3%A4est%C3%B6julkaisu_2021-2022_0.pdf. 25 Apr 2023.
  27. 27.↵
    1. Mendelson A,
    2. Kondo K,
    3. Damberg C,
    4. et al.
    (2017) The effects of pay-for-performance programs on health, health care use, and processes of care: a systematic review. Ann Intern Med 166 (5):341–353, doi:10.7326/M16-1881, pmid:28114600.
    OpenUrlCrossRefPubMed
  28. 28.↵
    1. Yuan B,
    2. He L,
    3. Meng Q,
    4. Jia L
    (2017) Payment methods for outpatient care facilities. Cochrane Database Syst Rev 3 (3), doi:10.1002/14651858.CD011153.pub2, pmid:28253540. CD011153.
    OpenUrlCrossRefPubMed
  29. 29.↵
    1. van Erp RMA,
    2. van Doorn AL,
    3. van den Brink GT,
    4. et al.
    (2021) Physician assistants and nurse practitioners in primary care plus: a systematic review. Int J Integr Care 21 (1), doi:10.5334/ijic.5485, pmid:33613138. 6.
    OpenUrlCrossRefPubMed
  30. 30.↵
    1. Cowling TE,
    2. Harris MJ,
    3. Watt HC,
    4. et al.
    (2014) Access to general practice and visits to accident and emergency departments in England: cross-sectional analysis of a national patient survey. Br J Gen Pract 64 (624):e434–e439, doi:10.3399/bjgp14X680533, pmid:24982496.
    OpenUrlAbstract/FREE Full Text
  31. 31.↵
    1. DiCenso A,
    2. Bourgeault I,
    3. Abelson J,
    4. et al.
    (2010) Utilization of nurse practitioners to increase patient access to primary healthcare in Canada – thinking outside the box. Nurs Leadersh (Tor Ont) 23 239–259, doi:10.12927/cjnl.2010.22281.
    OpenUrlCrossRefPubMed
  32. 32.↵
    1. Jiwani I,
    2. Fleury MJ
    (2011) Divergent modes of integration: the Canadian way. Int J Integr Care 11 . e018.
  33. 33.↵
    1. Krakau I
    (1991) Quantitative measures of medical activities in relation to diagnosis in primary health care. Health Policy 18 (2):151–157, doi:10.1016/0168-8510(91)90096-g.
    OpenUrlCrossRefPubMed
  34. 34.↵
    1. Blumenthal D,
    2. Causino N,
    3. Chang YC,
    4. et al.
    (1999) The duration of ambulatory visits to physicians. J Fam Pract 48 (4):264–271, pmid:10229250.
    OpenUrlPubMed
  35. 35.
    1. Hu P,
    2. Reuben DB
    (2002) Effects of managed care on the length of time that elderly patients spend with physicians during ambulatory visits: national ambulatory medical care survey. Med Care 40 (7):606–613, doi:10.1097/00005650-200207000-00007, pmid:12142776.
    OpenUrlCrossRefPubMed
  36. 36.↵
    1. Lo A,
    2. Ryder K,
    3. Shorr RI
    (2005) Relationship between patient age and duration of physician visit in ambulatory setting: does one size fit all? J Am Geriatr Soc 53 (7):1162–1167, doi:10.1111/j.1532-5415.2005.53367.x, pmid:16108934.
    OpenUrlCrossRefPubMed
  37. 37.↵
    1. Põlluste K,
    2. Kosunen E,
    3. Koskela T,
    4. et al.
    (2019) Primary health care in transition: variations in service profiles of general practitioners in Estonia and in Finland between 1993 and 2012. Health Policy 123 (1):37–44, doi:10.1016/j.healthpol.2018.10.002, pmid:30322719.
    OpenUrlCrossRefPubMed
  38. 38.↵
    1. Bashshur RL,
    2. Howell JD,
    3. Krupinski EA,
    4. et al.
    (2016) The empirical foundations of telemedicine interventions in primary care. Telemed J E Health 22 (5):342–375, doi:10.1089/tmj.2016.0045, pmid:27128779.
    OpenUrlCrossRefPubMed
  39. 39.↵
    1. Seah JY
    (2020) Barriers to making house calls by primary care physicians and solutions: a literature review. Malays Fam Physician 15 (3):3–9, pmid:33329858.
    OpenUrlPubMed
  40. 40.↵
    1. Hong M,
    2. Thind A,
    3. Zaric GS,
    4. Sarma S
    (2020) The impact of improved access to after-hours primary care on emergency department and primary care utilization: a systematic review. Health Policy 124 (8):812–818, doi:10.1016/j.healthpol.2020.05.015, pmid:32513447.
    OpenUrlCrossRefPubMed
Back to top
Previous ArticleNext Article

In this issue

BJGP Open
Vol. 7, Issue 3
September 2023
  • Table of Contents
  • Index by author
Download PDF
Download PowerPoint
Email Article

Thank you for recommending BJGP Open.

NOTE: We only request your email address so that the person to whom you are recommending the page knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Comparison of two GP service provider models in older adults: a register-based follow-up study
(Your Name) has forwarded a page to you from BJGP Open
(Your Name) thought you would like to see this page from BJGP Open.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Comparison of two GP service provider models in older adults: a register-based follow-up study
Aina Enckell, Merja K Laine, Hannu Kautiainen, Mika T Lehto, Kaisu H Pitkälä, Ossi Rahkonen, Hanna-Maria Roitto, Timo Kauppila
BJGP Open 2023; 7 (3): BJGPO.2022.0101. DOI: 10.3399/BJGPO.2022.0101

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Comparison of two GP service provider models in older adults: a register-based follow-up study
Aina Enckell, Merja K Laine, Hannu Kautiainen, Mika T Lehto, Kaisu H Pitkälä, Ossi Rahkonen, Hanna-Maria Roitto, Timo Kauppila
BJGP Open 2023; 7 (3): BJGPO.2022.0101. DOI: 10.3399/BJGPO.2022.0101
del.icio.us logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
  • Mendeley logo Mendeley

Jump to section

  • Top
  • Article
    • Abstract
    • How this fits in
    • Introduction
    • Method
    • Results
    • Discussion
    • Notes
    • References
  • Figures & Data
  • Info
  • eLetters
  • PDF

Keywords

  • continuity of patient care
  • follow-up
  • general practitioners
  • health services accessibility
  • patient appointments
  • Primary health care

More in this TOC Section

  • Podcasting in primary care: attitudes of Scottish GP specialty trainees and trainers towards podcast-based education in primary care
  • Patient perceptions of relational continuity in England: insights from two cross-sectional surveys
  • COVID-19 and patient-reported experience of general practice in England
Show more Research

Related Articles

Cited By...

Intended for Healthcare Professionals

 
 

British Journal of General Practice

NAVIGATE

  • Home
  • Latest articles
  • Authors & reviewers
  • Accessibility statement

RCGP

  • British Journal of General Practice
  • BJGP for RCGP members
  • RCGP eLearning
  • InnovAiT Journal
  • Jobs and careers

MY ACCOUNT

  • RCGP members' login
  • Terms and conditions

NEWS AND UPDATES

  • About BJGP Open
  • Alerts
  • RSS feeds
  • Facebook
  • Twitter

AUTHORS & REVIEWERS

  • Submit an article
  • Writing for BJGP Open: research
  • Writing for BJGP Open: practice & policy
  • BJGP Open editorial process & policies
  • BJGP Open ethical guidelines
  • Peer review for BJGP Open

CUSTOMER SERVICES

  • Advertising
  • Open access licence

CONTRIBUTE

  • BJGP Life
  • eLetters
  • Feedback

CONTACT US

BJGP Open Journal Office
RCGP
30 Euston Square
London NW1 2FB
Tel: +44 (0)20 3188 7400
Email: bjgpopen@rcgp.org.uk

BJGP Open is an editorially-independent publication of the Royal College of General Practitioners

© 2025 BJGP Open

Online ISSN: 2398-3795