NDLI: Change of primary health care service provider model in Vantaa: the impact on mortality and causes of death among older adults

Content Provider	Springer Nature : BioMed Central
Author	Enckell, Aina Roitto, Hanna-Maria Kautiainen, Hannu Lehto, Mika T. Pitkälä, Kaisu H. Kauppila, Timo Laine, Merja K.
Abstract	Background Access to primary health care (PHC) has declined in Finland in recent years. To address this, the city of Vantaa, Finland, transitioned from a named general practitioner (GP) model to a restricted-list GP model in 2011 to increase access to named GPs for the most vulnerable population. This study evaluates the impact of this model change on mortality rates and causes of death among older adults. Methods This register-based follow-up study was conducted in Vantaa, Finland, using data from the electronic health records. The study included all patient contacts aged 75 and older between 1 September 2004 and 31 August 2018. The primary outcome was the Standardised Mortality Ratio (SMR). We calculated excess deaths and examined cause-specific mortality trends before and after the restricted-list GP model implementation. Results During the study period, 32,034 PHC contacts were recorded. The SMR remained stable during the named GP model years but began to decrease during the restricted-list GP model, falling below expected levels from 2016 onward. Excess deaths decreased from 615 in 2004 in the named GP model to -29 by 2018, when the restricted-list GP model was in operation. Leading causes of death were circulatory diseases (41.1%), cancers (20.4%) and neurological conditions (17.8%), with a decrease in circulatory disease deaths and an increase in cancer and dementia-related deaths over time. Conclusions The transition to the restricted-list GP model was associated with a lower SMR and fewer excess deaths in older adults. These findings highlight the importance of ongoing assessment of PHC models to ensure they meet evolving healthcare demands.
Related Links	https://bmchealthservres.biomedcentral.com/counter/pdf/10.1186/s12913-025-12595-y.pdf
Ending Page	7
Page Count	7
Starting Page	1
File Format	HTM / HTML
ISSN	14726963
DOI	10.1186/s12913-025-12595-y
Journal	BMC Health Services Research
Issue Number	1
Volume Number	25
Language	English
Publisher	BioMed Central
Publisher Date	2025-03-27
Access Restriction	Open
Subject Keyword	Public Health Health Administration Health Informatics Nursing Research Access to care Cause of death Follow-up study General practitioner Named general practitioner Mortality Primary health care
Content Type	Text
Resource Type	Article
Subject	Health Policy

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