Changes in office-hours doctor and nurse consultations: six-year register-based follow-up cohort study in the public primary health care of City of Vantaa, Finland

To investigate how the number of face-to-face office-hours nurse consultations changed in response to the continuously decreasing number of consultations with general practitioners (GPs) in the fourth largest city in Finland, Vantaa we performed a retrospective register-based follow-up cohort study in public primary health care. The number of monthly consultations per practitioner in public primary health care were examined and counted from all recorded face-to-face office-hour consultations with GPs, practical nurses (PNs), registered nurses (RNs), and public health (PHNs) nurses of Vantaa's public primary health care system between 1 January 2009 and 31 December 2014. Over the follow-up period, the monthly mean number of GP consultations adjusted per practitioner decreased from 159 (mean; SD 29) in 2009 to 135 (16) in 2014 (p<0.001), and the number of RN consultations decreased from 34 (14) to 27 (7; p<0.001). There was no significant decrease in the practitioner-adjusted median monthly number of office-hour consultations with PN or PHN. The total number of monthly office-hour consultations per practitioner decreased from 40 (11) to 34 (6; p<0.001). In public office-hours PHC, face-to-face medical consultations have not automatically shifted from GPs to nurses. Surprisingly, recorded RN consultations may even decrease, and the overall productivity of PHC may worsen.