Unnecessary visits to health centres as perceived by the staff

The aim of this study was to assess the present situation concerning unnecessary visits to health centres as perceived by the primary health care staff. Associations of this perception with the internal work motivators were analysed. Data consisted of the personnel of four health centres located in various parts of Finland. A pretested questionnaire was employed with a response rate of 87%. The number of responders was 644, comprising 24 administrative staff, 146 general practitioners, 383 nursing staff, and 91 office staff. An estimate of the number of unnecessary visits (%) was obtained using a scale from 0 to 50%. Estimates less than 20% were regarded in the analyses as acceptable by the authors. The methods of analysis included cross tabulations and logistic regression. The theoretical framework for this research was a modification of the work motivation model by Hackman and Oldham. 41% of responders felt that at least 20% of patient visits could be characterized as unnecessary (49% of doctors, 37% of nursing staff). The health centres also differed from each other. The longer the doctors had worked in their present health centre, the less they regarded the visits as unnecessary. Among those doctors who had worked in the health centre less than four years, 63% indicated that 20% or more of all visits to doctors were unnecessary. There was no similar trend with nurses. With the doctors, the most important risk factors among the internal motivators for perceiving the proportions of unnecessary visits high were the lack of work significance and lack of task identity whereas with the nursing staff the important risk factors appeared to be the perceived lack of skill variety of the work and lack of task identity. The study suggests the need for specific postgraduate training for doctors who intend to work permanently in primary health care.