Frequent attenders in primary health care in Finland: use of primary care services and patient characteristics.

Student summary

Why This Research Matters

This article, published in the Scandinavian Journal of Primary Health Care in January 2026 and authored by Nygård et al., investigates frequent attenders (FAs) within primary health care settings in Helsinki, Finland. The study's main goal is to understand how these FAs use healthcare services, what their personal characteristics are (like age, gender, language), and the types of medical conditions they have. This research draws on data from administrative records covering a five-year period from 2015 to 2019 in Helsinki and its university hospital.

The authors define frequent attenders as individuals who fall into the top decile (the highest 10%) of annual users of primary health care services. This means they have more than seven face-to-face visits with either physicians or nurses each year within this system. The study includes both physician and nurse consultations, which is important because it highlights different parts of patient care.

The research found that FAs make up a small portion (15.9%) of all patients but account for almost half of all health care visits in the primary care setting studied. This shows they use services much more than others. The study also looked at how long someone was classified as an FA, categorizing them based on whether they met this frequent attendance criteria for 1 year, 2 years, up to 5 years.

Key characteristics of FAs identified in the study include being more often women and older adults (aged over 65). They were also more likely to be native Finnish speakers. Health-wise, chronic diseases and having multiple health problems (multimorbidity) were found to be more common among this group. Interestingly, a specific condition – chronic skin wounds – was strongly linked with frequent attendance.

The study observed changes in how FAs used services over time if their frequent attendance persisted for several years. Initially, physician visits might have been the main type of contact (around 0.7 annual visits per non-FA). However, as FA status continued into multiple years, there was a significant shift: physician visits increased to an average of 6.4 annually among those who were FAs for five consecutive years. More notably, nurse visits rose dramatically from about 0.6 annual visits (for non-FAs) to 11.4 annually among persistent FAs over the same period. This means that by the fifth year of being classified as an FA, nearly two-thirds of all contacts with primary health care for these individuals were with nurses.

For nursing students and practicing nurses, this study provides important insights. It shows that frequent attenders are a small but significant group in terms of healthcare resource use. Their high need is driven not only by physicians but disproportionately by nurses. This highlights the crucial role nurses play in managing complex patient needs over time. Students should consider how to assess patients for potential FA status, understand the common characteristics and conditions associated with FAs (like chronic skin wounds), and recognize that nursing care forms a substantial part of their ongoing management.

When appraising this research, students should note it's based on register-based cohort data from administrative records. This means it relies on existing healthcare system information rather than new surveys or experiments, which has its own strengths and limitations (e.g., completeness of data). The study uses statistical methods like the chi-square test and Poisson regression with robust variance estimation to analyze the data.

Regarding source rights and access, while PubMed lists this record, specific details about open access status, copyright, or licensing are not provided in the supplied metadata. Therefore, it's important for students to verify these aspects if they need to use the full text of the article beyond what might be available through institutional subscriptions or public repositories.

A nurse would reason from this evidence by understanding that a significant portion of primary care resources is consumed by FAs who often have complex needs and rely heavily on nursing services. This suggests that strategies for managing FAs should involve comprehensive assessments, coordinated care plans (often involving nurses), and potentially more proactive outreach or support to prevent their conditions from worsening and reducing the burden on both patients and the healthcare system.

The study underscores the importance of including nursing care in research and resource planning related to frequent attenders. It suggests that understanding the specific roles and contributions of nurses is vital for effective primary health care delivery, especially for this high-need population.

Faculty notes

Educational Relevance

This article by Nygård et al., published in the Scandinavian Journal of Primary Health Care (2026), offers a significant contribution to understanding frequent attenders (FAs) within Finnish primary healthcare. The study employs robust register-based cohort data from Helsinki and its university hospital spanning 2015-2019, focusing on service utilization patterns, sociodemographic profiles, and diagnostic characteristics of FAs defined as the top decile of annual primary care users with more than seven face-to-face visits.

The research reveals that despite constituting only 15.9% of patients, FAs account for nearly half of all health care visits in this setting. This highlights a critical resource allocation issue where a small subgroup consumes substantial services. The study meticulously categorizes FAs based on the duration (1-5 years) they meet FA criteria, allowing for nuanced analysis of service use evolution.

Key findings include: FAs are predominantly women and individuals aged over 65; native Finnish speakers were more common among this group; chronic diseases and multimorbidity are highly prevalent. A particularly strong association was found between chronic skin wounds and frequent attendance. The study's longitudinal aspect is valuable, showing how service use shifts as FA status persists: physician visits increased from ~0.7 (non-FAs) to 6.4 annually for persistent FAs over five years, while nurse visits surged even more dramatically—from ~0.6 to 11.4 annually—comprising nearly two-thirds of contacts among those with long-term FA status.

This research is crucial for nursing education and practice as it quantifies the significant role nurses play in managing this high-need population. It underscores that FAs' service use, particularly over time, becomes increasingly nurse-centric. For faculty, this study provides a solid empirical basis to discuss topics such as resource allocation in primary care, the management of chronic conditions (especially wound care), understanding multimorbidity, and the evolving roles within interprofessional teams where nursing contributions are paramount for FAs.

The use of administrative registry data is both a strength and a potential limitation. While it offers large-scale insights into real-world service patterns, it may lack detail on patient-reported outcomes or unmeasured confounders not captured in registries (e.g., social determinants beyond language). The statistical methods employed (chi-square test, Poisson regression with robust variance estimation) are appropriate for analyzing prevalence ratios and associations within this type of data. For nursing students, the study serves as a practical example of how epidemiological research can inform clinical practice and health policy regarding vulnerable populations in primary care.