| 1. |
- Reho, T, et al.
(author)
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Occupational health patients' parallel use of primary- and secondary-care services and linkage to work disability: A follow-up study in Finland
- 2024
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In: Scandinavian journal of public health. - : SAGE Publications. - 1651-1905 .- 1403-4948. ; 52:2, s. 128-135
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Journal article (peer-reviewed)abstract
- This study aimed to investigate occupational health (OH) primary-care patients’ use of other health-care services and whether parallel use affects their likelihood to have sickness absences (SA) or disability pensions (DP). Methods: Primary-care services in Finland are provided through three parallel health-care sectors, all available to the working population: public, private and OH sectors. Patients may also be referred to secondary care. This follow-up study combines real-world medical record data containing SA data from a nationwide OH provider with health-care attendance data from public and private primary-care sectors and public secondary care, sociodemographic data and DP decisions. Patients between 18 and 68 years of age who used OH primary care at least once during the study years 2014–2016 were included. The total study population comprised 59,650 patients. Odds ratios were used to analyse association between parallel service use and SA or DP. Results: Females and patients with a lower educational level were more likely to use services in other health-care sectors in addition to OH than others. Those patients who used any other health-care sector in addition to OH primary care had an increased likelihood of having long SA or receiving DP. Conclusions: OH primary-care patients using the services of several health-care sectors in parallel have an increased likelihood of receiving disability benefits – either SA or DP. There is need for care coordination to ensure adequate measures for work-ability support.
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| 2. |
- Reho, TTM, et al.
(author)
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Parallel use of primary and secondary healthcare by frequent attenders in occupational health and their work disability: a longitudinal study in Finland
- 2022
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In: BMJ open. - : BMJ. - 2044-6055. ; 12:4, s. e052740-
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Journal article (peer-reviewed)abstract
- To investigate occupational health frequent attenders’ (FAs) use of other healthcare sector services and whether parallel use affects their likelihood to receive a disability pension.DesignLongitudinal study combining routine medical record data with register data.SettingPrimary care in Finland is provided through three parallel healthcare sectors, all available to the working population. Additionally, patients can be referred to secondary care. This study combines medical record data from a nationwide occupational healthcare provider, with healthcare attendance data from private care and from public primary and secondary care attendance, sociodemographic data and disability pension decisions.ParticipantsPatients between 18 and 68 years of age who used occupational health primary care at least once during the study years 2014–2016 were included. The total study population was 59 650 patients. They were divided into three groups (occasional and persistent FAs and non-FAs) for analysis.Primary and secondary outcome measuresThe primary outcome was FAs parallel use of private care and public primary and secondary care. The secondary outcome was work disability pension granted to FAs who used several healthcare sectors.ResultsBoth FA groups were more likely to use other healthcare service sectors more than non-FAs did. Persistent FAs were likely to use public secondary care services in particular (OR 4.31 95% CI 3.46 to 5.36). FAs using all healthcare sectors were also more likely to receive a disability pension than those FAs using only occupational health services (OR 4.53 (95% CI 1.54 to 13.34). This association was strengthened by attendance in public secondary care.ConclusionsFAs using several healthcare sectors in parallel have an increased likelihood to receive a disability pension. There is need for care coordination to ensure adequate measures for work ability support.
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| 5. |
- Vahatalo, L, et al.
(author)
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Cooperation between Public Primary Health Care and Occupational Health Care Professionals in Work Ability-Related Health Issues
- 2022
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In: International journal of environmental research and public health. - : MDPI AG. - 1660-4601. ; 19:19
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Journal article (peer-reviewed)abstract
- Work disability creates significant expenses for nations and causes human suffering by limiting patients’ lives. International studies show that to enhance recognition of and support for work disability, cooperation, mutual trust, and information exchange between public primary health care and occupational health care must be strengthened. However, little is known of how health care professionals experience this cooperation. The aim of this study was to understand how professionals experience the cooperation between public primary health care and occupational health services regarding patients’ work ability. Semi-structured interviews were conducted with 29 health care professionals working in five small cities (<10,000 inhabitants) in Finland. Interviews were audio and video recorded, transcribed verbatim, and analyzed through inductive thematic analysis. Three key themes were identified from the interviews: attitudes toward the other health care sector, the exchange of information, and resources for cooperation. Professionals seem to have poor knowledge about the services available and how care is given in the other sector, appearing to lead to weak mutual trust. The public primary health care professionals especially emphasized the benefits of cooperation, but several issues were mentioned as barriers to cooperation. These results can be used when planning effective patient paths and service provisioning models.
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| 6. |
- Reho, TTM, et al.
(author)
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Frequent attenders at risk of disability pension: a longitudinal study combining routine and register data
- 2020
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In: Scandinavian journal of public health. - : SAGE Publications. - 1651-1905 .- 1403-4948. ; 48:2, s. 181-189
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Journal article (peer-reviewed)abstract
- Aims: Frequent attendance in healthcare services is associated with ill-health and chronic illnesses. More information is needed about the phenomenon’s connection with disability pensions (DPs). Methods: The study group comprised 59,676 patients divided into occasional- (1yFAs) and persistent frequent attenders (pFAs) and non-frequent attenders (non-FAs). Odds ratios for DP were analysed for these groups taking into account preceding sickness absence days. The awarded DPs were obtained from the Finnish Centre for Pensions and data on primary care visits were obtained from Pihlajalinna, a nationwide occupational healthcare provider. Results: 1yFAs and pFAs have more DPs than non-FAs. During follow-up, 14.9% of pFAs, 9.6% of 1yFAs and 1.6% of non-FAs had a DP decision of any kind. pFAs receive more partial and fixed-term decisions than the other groups and most permanent DPs are granted to 1yFAs. Musculoskeletal disorders are the most common reason for illness-based retirement in all groups but 1yFAs and pFAs have proportionally more mental disorders leading to DP. The group of non-FAs, on the other hand, has more DPs granted based on neoplasms. Both 1yFAs and pFAs have an increased risk of DP but the effect is diluted after taking into account preceding sick-leave. Conclusions: Frequent attendance of healthcare services, both occasional and persistent, is associated with increased risk of future DP. The association is linked to increased sickness absences. Frequent attenders should be identified and their rehabilitative needs evaluated. Frequency of consultation could be used in selecting candidates for early rehabilitation before sickness absences develop.
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| 7. |
- Reho, TTM, et al.
(author)
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Frequent attenders in occupational health primary care: A cross-sectional study
- 2019
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In: Scandinavian journal of public health. - : SAGE Publications. - 1651-1905 .- 1403-4948. ; 47:1, s. 28-36
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Journal article (peer-reviewed)abstract
- Aims: This study characterizes frequent attenders in primary care provided by occupational health services (OHS) in Finland. Methods: This is a nationwide cross-sectional study using medical record data from an OHS provider in 2015. Frequent attenders were defined as persons who were within the top decile of annual visits to healthcare professionals (frequent attender 10%, FA10) at any of the OHS’s 37 stations. FA10s within this study consulted the OHS primary care unit eight or more times during 2015. We used logistic regression to analyse factors associated with frequent attendance in OHS primary care. The independent variables were age, gender, employer size and industry, health professionals visited and diagnoses given during visits to the OHS. The dependent variable was belonging to the FA10 group. Results: Altogether 31,960 patients met the inclusion criteria and were included in the study. The FA10 group included 3617 patients, who conducted 36% of visits to healthcare professionals. The findings indicate that working within the manufacturing industry, health and social services, or public administration, and being employed in medium or large companies, are associated with frequent attendance. Frequent attendance was also associated with being female, diagnoses of the musculoskeletal system, or mental and behavioral disorders. In particular, depressive episodes and anxiety were associated with FA10s. Conclusions:This research characterized FA10 clients at a Finnish OHS. Illnesses of the musculoskeletal system and mental and behavioral disorders were accentuated among FA10s. The stability of the FA10 group, along with their sickness absences and work disabilities, should be investigated further.
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| 8. |
- Reho, TTM, et al.
(author)
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Occasional and persistent frequent attenders and sickness absences in occupational health primary care: a longitudinal study in Finland
- 2019
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In: BMJ open. - : BMJ. - 2044-6055. ; 9:2, s. e024980-
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Journal article (peer-reviewed)abstract
- Frequent attenders (FAs) create a substantial portion of primary care workload but little is known about FAs’ sickness absences. The aim of the study is to investigate how occasional and persistent frequent attendance is associated with sickness absences among the working population in occupational health (OH) primary care.Setting and participantsThis is a longitudinal study using medical record data (2014–2016) from an OH care provider in Finland. In total, 59 676 patients were included and categorised into occasional and persistent FAs or non-FAs. Sick-leave episodes and their lengths were collected along with associated diagnostic codes. Logistic regression was used to analyse associations between FA status and sick leaves of different lengths (1–3, 4–14 and ≥15 days).ResultsBoth occasional and persistent FA had more and longer duration of sick leave than non-FA through the study years. Persistent FAs had consistently high absence rates. Occasional FAs had elevated absence rates even 2 years after their frequent attendance period. Persistent FAs (OR=11 95% CI 7.54 to 16.06 in 2016) and occasional FAs (OR=2.95 95% CI 2.50 to 3.49 in 2016) were associated with long (≥15 days) sickness absence when compared with non-FAs. Both groups of FAs had an increased risk of long-term sick leaves indicating a risk of disability pension.ConclusionBoth occasional and persistent FAs should be identified in primary care units caring for working-age patients. As frequent attendance is associated with long sickness absences and possibly disability pensions, rehabilitation should be directed at this group to prevent work disability.
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| 9. |
- Saukkosalmi, P., et al.
(author)
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Defined daily dose definition in medication adherence assessment in asthma
- 2023
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In: European Clinical Respiratory Journal. - 2001-8525. ; 10:1
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Journal article (peer-reviewed)abstract
- Adherence to inhaled corticosteroids (ICS) has been described as poor. In adherence studies, if the actual prescribed dosing is not available, generic defined daily doses (DDD) are applied instead when assessing adherence. We evaluated asthma patients' adherence in a large prospective follow-up survey. We also analysed whether World Health Organization (WHO) and Global Initiative for Asthma (GINA) reference doses give different results. The current study was cross-sectional and included respondents attending to HeSSup follow-up questionnaire in 2012. Altogether 1,141 of 12,854 adult participants answered positively to the question about having asthma. According to the Finnish Social Insurance Institutions' medication register, 686 of them had purchased ICS medication during 2011. DDDs for ICS by WHO as well as medium doses from GINA report were used as reference doses to evaluate adherence. To estimate adherence to ICS, the proportion of days covered (PDC) over one year was calculated for every patient. If the lower limit of GINA medium ICS dose was used as a reference, 65% of the patients were adherent (PDC >= 80%). Use of WHO's DDD as reference halved the proportion of adherent patients. Adherence was higher among those using a combination inhaler of corticosteroid and long-acting beta(2)-agonist compared to those using steroid only inhalers. Use of WHO's daily defined doses as reference values may lead to underestimation of adherence to inhaled corticosteroids. Thus, attention should be paid when choosing the reference doses for the evaluation of adherence to inhaled corticosteroids in asthma.
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