Where have all the back pains gone? Changes in the reasons for requiring out-of-hours medical care from a centralized primary care centre after changing to a list system

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Abstract
Objective.We aimed to study changes in reasons for seeking assistance during out-of-hours work in a single health centre before and after introduction of the list system.Method.A questionnaire concerning all out-of-hours general practice consultations for 1 week each month in two separate years (in 1990 and 1993) was completed in one health centre in central Finland (Palokka health centre) in a region with 39 465 inhabitants (37 960 inhabitants in 1990). All patients contacting the health centre to request medical help during out-of-hours work were asked to complete the questionnaire. Outcome measures were consultation rates by ICPC main codes.Results.The annual out-of-hours consulting rate per 1000 inhabitants decreased from 823 to 533 (35%) (P < 0.001). The clearest decrease (57%) from 172 to 74 consultations per 1000 inhabitants occurred in patients with musculoskeletal problems. A marked reduction (75%; from 52 to 13 consultations per 1000 inhabitants) was found in male patients with back symptoms. For female patients with neck problems the reduction of out-of-hours consultations was also marked (67% reduction; from 12 to 4 consuttations per 1000 inhabitants).Conclusions.Improvement of continuity of care for patients having musculoskeletal problems is partly a question of organization, and it is also economically justifiable.

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