Strong scientific evidence* indicates that when patients are treated by the same general practitioner:
- quality of care is improved
- patient satisfaction is improved
- morbidity and mortality rates are significantly reduced
- overall health care needs and costs are reduced
In addition, the work of professionals becomes easier when the basic health status of the customer is already known and the discussion can continue from where it was left off the last time. As the aforementioned things can be considered facts, it would feel very strange if we did not invest more in the continuity of care. At Mehiläinen, the theme is important in both public health care services and our occupational health care services.
Mehiläinen health centre uses THL’s COC index
In Mehiläinen’s public health care services, improving the continuity of care is one of the key projects for 2023, both at our health centres and in the home services for the elderly.
We measure the continuity of care at our health centres using the Continuity of Care (COC) index, as defined by the Finnish Institute for Health and Welfare (THL). As such, COC is not suitable as a measure of the continuity of care in home services for patients who receive three or more visits per day because, due to working time legislation, there must be several nurses. In home services, we measure the number of different nurses for the same patient on a monthly basis and monitor how many of our customers we are able to make monthly visits to with five nurses.
We have set a goal for 2023 to increase the continuity of care in all our health centres to the top third in Finland. Continuity of care will be improved by making its benefits better known to employees, by making continuity of care a central part of the development of operating models and by actively monitoring the results.
In Norway, which is considered a model country for continuity of care, the COC index varies between 0.54 and 0.57, while the Finnish average is 0.31. Of the municipal health centres in Finland, only 16 reach the level of Norway. Two of these are currently part of Mehiläinen’s public health care services.
Continuity of care at Mehiläinen’s public health centres in 2021.
(Includes Harjun terveys health centres, which are part of Mehiläinen and Päijät-Häme’s joint venture.)
No official COC indices for occupational health care services yet – preliminary results are excellent
THL has not so far defined official COC indices for occupational health care, but we have expressed our interest in defining the indices.
The Occupational Health Care Act requires that the employer, employee and occupational health care provider work together to promote the prevention of work-related diseases and accidents and the health and safety of work and the work environment. Employees’ health, work ability and functional capacity at different stages of their careers and as part of the work community’s activities must also be promoted.
This is our statutory core mission: preventive measures to support work ability and preventing work-related diseases form a service package that applies to all of our customers. A multidisciplinary occupational health team has been appointed for each occupational health customer. The team is responsible for monitoring work ability, responding to support needs and assessing work ability. Providing occupational health care is voluntary for employers and agreement-specific in scope, which may have an impact on the formation of the COC index.
As a result, continuity of care in Mehiläinen’s occupational health care services was determined on the basis of statutory appointments with occupational health physicians and occupational health nurses.
The continuity of care in terms of statutory occupational health care was:
- 0.73 for appointments with a physician
- 0.67 for appointments with a nurse
The results are excellent and show that the continuity of care within the designated occupational health team is in line with expectations and the law. The benefits achieved are consistent with the public health care research evidence – the quality of care and patient satisfaction are improved.
This also strengthens the implementation of measures related to work ability support, such as occupational health negotiations, that are carried out together with the employer, employee and the multidisciplinary occupational health team. When both the employee and the employer’s representative can rely on the continuity of care with the same multidisciplinary occupational health team, qualitative, quick and cost-effective results are achieved.
Continuity of care for Mehiläinen Working Life Services’ statutory appointments.
In addition to continuity of care, availability of care is also important
It should be noted that according to THL’s definitions, the COC index is calculated only for patients who have at least three non-urgent appointments with a representative of the same health care professional group (physician/nurse) within two years. According to our data search, this amounts to less than 10% of the population in public healthcare services. The remaining 90% are not directly included in the COC calculation. For them, the most important thing is to have their symptoms treated quickly. This means that the availability of care is a key factor in the overall functioning of health care. At Mehiläinen’s public health centres, third non-urgent appointments with a physician were available within an average of 5.3 days in 2022.
Occupational health care services make up a specialised medical clinic for work ability assessment, where all activities should be aimed at finding measures to support an employee with partial work ability in cooperation with the employer. Success in this requires continuity of the care relationship with the same multidisciplinary occupational health team when it comes to both the employee and the customer company. When all parties are familiar with the work ability management model in the workplace and the possibilities for modifying work, we can use support for early return to work to prevent early retirements due to disability and increased pension costs as well as lost tax income in the national economy.
*) Reports and memos by the Ministry of Social Affairs and Health 2022:17: Omalääkärisi 2.0 report
The blog post was written by Henri Ärölä, Mehiläinen’s Medical Director of Public Health Care, and Sirkku Martti, Mehiläinen’s Medical Director of Occupational Health.