Changes in location and number of nurse consultations as the supply of general practitioners decreases in primary health care: six-year register-based follow-up cohort study in the city of Vantaa, Finland

Abstract

Objective To investigate whether the location and the number of nurse consultations have changed in response to the continuously decreasing number of GP consultations in the fourth-largest city in Finland. It has been suggested that nurse consultations are replacing GP consultations. Design A retrospective register-based follow-up cohort study. Setting Public primary health care in the City of Vantaa, Finland. Subjects All documented face-to-face office-hour consultations with practical and registered nurses, and consultations with practical and registered nurse in the emergency department of Vantaa primary health care between 1 January 2009 and 31 December, 2014. Main outcome measures Change in the number of consultations with practical and registered nurses between 2009 and 2014 in primary health care both during office-hours and in the emergency department. Results Over the follow-up period, the monthly median number of practical nurse consultations in the emergency department per 1000 inhabitants increased from 1.6 (interquartile range [IQR] 1.3–1.7) to 10.5 (10.3–12.2) (p < 0.001) and registered nurse consultations from a median of 3.6 (3.0–4.0) to 14.5 (13.0–16.6) (p < 0.001). However, there was no significant change in the median monthly number of office-hour consultations with practical or registered nurses. Conclusions It appears that in primary health care, medical consultations have shifted from GPs to nurses with lower education levels, and from care during office-hours to emergency care.