Use of primary healthcare services before and after specialized rehabilitation and its relation to changes in health and functioning: a longitudinal cohort study

Abstract

Objective: To examine patients’ use of primary healthcare (PHC) before and after specialized rehabilitation and its relation with self-reported health and functioning. Design: Longitudinal cohort study. Participants: 451 rehabilitation patients. Methods: Register data were used to measure the frequency of visits to the general practitioner (GP) and physiotherapist (PT) in PHC 3 years before and after rehabilitation. Patients reported health (EQ-VAS) and functioning (SF-36) before rehabilitation and at 1 and 3 years after. Data are described for the total study cohort and subgroups with musculoskeletal disease (MSD) and cardiovascular disease (CVD). Results: There was an increase in GP and PT visits preceding rehabilitation and a gradual decrease thereafter. An exception was GP visits among patients with CVD, with few diagnosis-specific visits before but an increase after. Lower levels of health and functioning tended to be related to more frequent GP and PT visits. An indication of clinically important improvement was found among those with frequent GP visits in the MSD subgroup, and among those with 1–2 GP visits in the CVD subgroup. Conclusions: The diverse relationship between health and functioning, and the use of PHC services at follow-up, may imply that additional factors besides healthcare use explain long-term improvement following rehabilitation.