Frequent Attenders of Occupational Health Primary Care and Work Disability

High consultation frequency in healthcare is associated with ill-health, chronic illnesses and multimorbidity. Frequent attenders (FA) also create a substantial share of primary care’s workload and costs. This phenomenon has been researched widely in the field of general practice, but information is scarce on working-aged patients, not to mention the working population. Additionally, minimal knowledge exists about the association between frequent attendance and sickness absences or disability pensions (DP).

Occupational health services (OHS) aim to support work ability and staying in the working life. Identifying individuals at risk of work disability is needed to enable these aims. At the moment, sickness absences and surveys aid in identifying work ability risks but additional and possible earlier measures would be welcome to enable timely actions. The known association between frequent attendance and poor health and chronic illnesses suggests that FAs might also be at risk of disability.

This study’s aim was to examine FAs in occupational health (OH) primary care in Finland, focusing on the working population. This study aimed to characterise FAs in this context and examine the differences between occasional and persistent FAs. The present study also looked into sickness absences of different lengths and diagnostic groups leading to sickness absences in different FA-groups compared with other users of OH primary care. This study also aimed to study differences in DPs of different FA groups and compare them to other users of OH primary care.

This study combined electronic medical record data and national pensions register data. The study consisted of cross-sectional and longitudinal studies and used routine medical record data (2014–2016) from a nationwide OHS provider in Finland. In total, 78 507 patients constituted the study population before exclusions; after exclusions, the study populations varied between 31 960 – 66 831 patients. FAs were defined across all the studies as the top 10% of patients using services in the study year(s). Patients categorised as FA in one year were considered occasional FA; patients who were FA in all three study years were considered persistent FA. The patients who belonged to the remaining 90% were considered as the reference group, non-FA. Additionally, to sociodemographic and background data, sick-leave episodes and their lengths were collected along with associated diagnostic codes. DP decisions were obtained from the Finnish Centre for Pensions (FCP) from 2015 – 2017 and were linked to the data.

Frequent attendance in the context of OH primary care was associated with the female gender, working for medium or large employers and working in the manufacturing industry or human health and social services. One in five occasional FAs continued as persistent FAs for three consecutive years, and in one year, the FAs created 36% of all consultations. FAs created 40% of primary care consultations throughout the study years.

Both occasional and persistent FAs had more and longer sick leave (SL) durations than non-FAs through the study years. Persistent FAs had consistently high absence rates, and occasional FAs had elevated absence rates, even 2 years after their frequent attendance period. Both persistent FAs and occasional FAs were associated with long (≥15 days) sickness absences when compared with non- FAs. Occasional and persistent FAs also had more DPs than non-FAs. During follow-up, 14.9% of pFA, 9.6% of 1yFA and 1.6% of non-FA had any of these incidents. Musculoskeletal disorders are the most common reason for illness-based retirement in all groups. However, occasional and persistent FAs had proportionally more DPs based on musculoskeletal disorders than other users of OH primary care and proportionally more than in the whole population as well.

FAs spend healthcare resources considerably, and frequent attendance was shown to be a risk for future sickness absence and DPs. Frequency of medical visits is a possible indicator that could be used to identify patients in need of care coordination and rehabilitation. The use of consultation frequency along with other indicators might enable earlier identification of disability risks, thus allowing timely interventions and follow-up planning.