搜索结果：Scandinavian journal of primary health care

The Health Assessment Tool (HAT) is a validated instrument designed to comprehensively assess the health of older adults. This study examinedthe feasibility and acceptability of implementing the HAT in Swedish primary care, while exploring older patients' needs and professional perspectives, drawing on experiences from a multicenter prospective validation study. A qualitative design was employed using reflexive thematic analysis. Data were collected through semi-structured interviews with patients and healthcare managers, and a focus group discussion with healthcare staff familiarized with the HAT in six Swedish primary care centers. Analysis followed Braun and Clarke's six-phase thematic approach, integrating inductive and deductive reasoning. The analysis constructed one overarching theme: 'For the needs left waiting, the HAT is a feasible bridge to holistic care of older adults', supported by two main themes: 'Voices of aging, unmet needs unveiled' and 'The HAT: a dependable compass for decision making in the care of older people'. Findings revealed challenges for older adults, including rapid health decline, loss of independence, loneliness, and gaps in primary care. The HAT was positively received for its comprehensive, person-centered approach, despite some concerns regarding time required for its assessment. The HAT was perceived as feasible and acceptable by older patients and healthcare providers, with the potential to transform care of older adults through proactive, holistic assessments. Its use may foster collaboration between health and social care professionals, a key prerequisite for meeting the complex needs of older people. Future research should evaluate a HAT-based model to support its integration into routine primary care.

Chat-based digital clinics have become an increasingly important gateway to primary healthcare in many countries. This exploratory study describes the socio-demographic characteristics of digital clinic users, examines patterns of digital clinic use among potentially vulnerable population groups, and compares the medical reasons for chat-based digital clinic contacts with those of traditional primary care. We conducted an observational register-based study using nationwide data covering digital and traditional contacts to public and private primary care clinics in Finland from January 2022 to February 2025. Using a rich linked dataset, we examined several potentially vulnerable socioeconomic subgroups, including individuals aged 80 and above, those with multimorbidity, the unemployed, and members of the lowest income quintile. The study population comprised 1,599,588 individuals residing in eight wellbeing services counties in Finland. Public digital clinic users appeared to be younger, more often women, and more often live in urban areas, and have a lower prevalence of chronic illnesses compared with users of traditional public primary care. Potentially vulnerable patient groups also used digital services, although they used traditional services more. Medical reasons for digital clinic contacts were often relatively simple, but individuals with chronic illnesses also used digital services to address their care needs. We observed differences in the characteristics of users of digital and traditional primary healthcare services. We generated hypotheses for future research on equity in digital healthcare access. Further research is needed to evaluate whether improving access to digital services for vulnerable groups could support health equity. Differences were observed between users of digital and traditional primary healthcare services.Potentially vulnerable patient groups also used digital services, although traditional services appeared to remain more commonly used among these groups.A higher number of digital clinic contacts was observed among individuals with greater previous healthcare useMedical reasons for digital clinic contacts were often relatively simple, although individuals with chronic illnesses also used digital services to address their care needs.The findings highlight the need for further research on how digital clinics can be developed to support accessibility and equity across population groups.Future research should examine how digital tools may support continuity of care in primary healthcare.

This study investigated frequent attenders (FAs) in primary health care in Helsinki, Finland, focusing on their service use, sociodemographic characteristics (sex, age, and language), and diagnostic profiles using registry data. Register-based cohort data were drawn from administrative records in primary, specialised, and oral health care of the City of Helsinki and Helsinki University Hospital (2015-2019; n = 297 845). FAs were defined as the top decile of annual primary health care users. Physician and nurse face-to-face visits were included. Patients were categorised by how many years (1-5) they met FA criteria. Statistical analyses were performed using the χ2 test or, when appropriate, Poisson regression with robust variance estimation to estimate prevalence ratios (PRs). Frequent attenders had more than seven annual face-to-face primary health care visits. Although representing only 15.9% of patients, FAs accounted for nearly half of all health care visits. FAs were more often women, aged over 65, and native Finnish speakers. Chronic diseases and multimorbidity were more prevalent among FAs. Chronic skin wounds were strongly associated with frequent attendance. As attendance persisted, visit distribution shifted: physician visits increased from 0.7 among non-FAs to 6.4 among 5-year FAs, while nurse visits rose from 0.6 to 11.4 annually, comprising nearly two-thirds of contacts among persistent FAs. FAs represent a small but high-need group in primary health care. Their service use is driven not only by physicians but disproportionately by nurses, highlighting the importance of including nursing care in research and resource planning.

Digital symptom checkers might help facilitate effective triage in primary healthcare. However, evidence regarding their acceptance among healthcare professionals remains limited. Identifying key factors of adoption is essential for successful integration into clinical practice.This study aims to identify factors most relevant to nurses' acceptance of a newly implemented digital triage platform and map their opinions regarding its use in Swedish primary healthcare. A cross-sectional quantitative survey study based on an extended Unified Theory of Acceptance and Use of Technology (UTAUT) framework was distributed to nurses involved in digital triage at 82 primary healthcare centers in Sweden. 164 registered nurses participated. The platform, 1177-direct, is an online symptom checker used in triage. Associations between extended UTAUT constructs and 'Intention to use/recommend' were analyzed using linear regression models. Nurses reported overall negative perceptions of the platform, with 61.6% expressing low 'Intention to use/recommend'. All constructs showed significant associations with 'Intention to use/recommend' in simple regressions. In the multiple regression models, 'Performance' was the strongest construct (β = 0.75 and 0.58), followed by 'Effort' in the original UTAUT model and 'Information transfer' and 'Work environment' in the extended model. Nurses' acceptance of the digital triage platform was primarily associated with perceived improvements in work performance. While extending the UTAUT model with context-specific constructs enhanced explanatory power, results should be interpreted with caution given limitations such as cross-sectional design, construct overlap and shared method variance. The results emphasize the need for contextualized frameworks when evaluating eHealth implementation in primary healthcare.

Indigenous peoples tend to differ from their non-Indigenous counterparts in use of health care services. Lack of available services, socioeconomic disparities, communication barriers and lack of trust have been found to be barriers driving the observed differences. The aim of this study is to investigate ethnic differences in the use of assigned general practitioner and emergency health care (2012-2019) while adjusting for age, length of education, and county of residence. Data from the SAMINOR 2 Questionnaire Survey was linked to records from the Norwegian Control and Payment of Health Refunds Database. Sami ethnicity was the primary exposure variable. Differences in mean number of consultations were investigated using the two-sample t-test. Adjustments for age (18-69&#x2009;years), county of residence (Nordland/Tr&#xf8;ndelag, Troms, Finnmark) and years of education (&#x2264;12&#x2009;years, >12&#x2009;years) were done using the generalized linear models Poisson loglinear and Negative binomial with log link. The study population consisted of 10,694 individuals: 5986 women (28.9% Sami) and 4708 men (22.7% Sami). Sami individuals had a significantly higher mean use of emergency medical care annually, and over the entire study period (2012-2019): Women (Sami 0.51, non-Sami 0.31, p&#x2009;<&#x2009;0.01), Men (Sami 0.40, non-Sami 0.25, p&#x2009;<&#x2009;0.01). However, no significant differences were observed in use of general practitioners. Adjusting for covariates did not alter the results for either outcome. The findings highlight ethnic disparities in primary healthcare utilization, showing higher use of emergency medical care in Sami compared to non-Sami. Further research should explore the underlying and probably multifaceted factors driving the observed differences.

Irritable bowel syndrome (IBS) is a common condition that should be diagnosed using the Rome criteria and limited laboratory testing. The aim of this retrospective, medical record-based study was to evaluate the adherence of Swedish primary health care practitioners to diagnostic guidelines for IBS. Using the electronic patient register in primary care, we identified 1943 new IBS cases in patients aged 18-65 between January 2015 and December 2019 in Region &#xd6;rebro County. A random sample of 400 patients was selected and their medical records were scrutinized to evaluate diagnostic methods. Of the 309 eligible medical records, only 36.2% of patients met the Rome III or IV criteria. The criteria were explicitly documented in 4.9% of cases, and subclassification was noted in 5.5%. There were no significant differences in diagnostic practices between GPs and other physicians. Only 9.4% were diagnosed without laboratory testing, although 69.9% did not undergo all recommended tests according to local guidelines. Rectoscopy was performed in 14.2%, while 9.7% and 5.8% of patients were referred for colonoscopy or CT, respectively, with significantly higher referral rates in patients over 40&#x2009;years. Men were more frequently referred for colonoscopy while other diagnostic procedures showed no significant sex differences. Adherence to IBS diagnostic guidelines in Swedish primary care seems to be limited among both GPs and non-GPs. The documented use of Rome criteria is minimal, and guideline-compliant laboratory testing is insufficient. Increased awareness and structured implementation of IBS diagnostic criteria are warranted.

With rapid technological development and new triage systems in primary healthcare, care complexity is increasing, reshaping the landscape of patient safety. Despite their growing integration, little is known about how healthcare professionals safeguard patient safety during triage. Therefore, this study aimed to explore how healthcare professionals manage patient safety during the triage process in digital primary care. An inductive and explorative research design was employed, using qualitative content analysis to analyse interviews with ten participants. The participants were healthcare professionals experienced with various triage systems. Three themes were identified: acting as a fine-tuned instrument to avoid mistriage, resolving technical interruptions to prevent triage delays, and mitigating organisational disruptions to ensure adequate assessment. These themes reflected the participants' continuous problem-solving efforts to maintain patient safety throughout the triage process. The findings suggest that triage systems may be overly simplified, shifting greater responsibility to healthcare professionals, who must interpret system outputs and manage the broader complexities of primary care triage. We argue that triage safety emerges from the interaction between an understanding of the healthcare system's contextual capacity, broad medical knowledge, and the interpersonal skills needed to recognise and respond to each patient's unique situation. Clinically, it is essential to define in advance the boundaries and procedures of the triage process, the mode of digital integration, and the system's intended purpose. Specifying these elements helps ensure that the digital tool supports rather than complicates clinical work and helps establish the preconditions necessary for patient safety.

Hypothyroidism is a prevalent endocrine disorder predominantly managed in primary care. Improper treatment can lead to significant clinical and public health consequences. Despite the availability of clear clinical guidelines, over- and undertreatment frequently occur. The aim was to explore and map indications of over- and undertreatment of hypothyroidism in a primary care setting. We conducted a scoping review guided by Arksey and O'Malley. The search was conducted in PubMed, Embase, CINAHL, Scopus, and the Cochrane Library. We included peer-reviewed studies exploring over- and undertreatment of hypothyroidism in primary care and included both registry/audit and survey studies. Data were extracted across four structured stages, capturing study characteristics and treatment-related outcomes. Data on indications were compared across studies to identify recurring patterns. Nineteen studies were included. The findings show that the majority of studies with larger study populations report a moderate prevalence of over- and undertreatment. Overtreatment was associated with early initiation of therapy, absence of confirmatory testing, and suppressed TSH levels during follow-up. Undertreatment was linked to incomplete diagnostic evaluation, delayed treatment initiation, and inadequate follow-up. Survey studies reported similar patterns of inappropriate management but higher adherence to clinical guidelines. This scoping review found consistent evidence of both over- and undertreatment of hypothyroidism in primary care. A discrepancy between clinicians' reported intentions and observed practice suggests the need to attend to behavioural and organisational factors, and to provide greater support for individualised decision-making to improve care.

Formal training is commonly used in electronic health record (EHR) implementation, but often fails to address healthcare professionals' ongoing, context-specific learning needs. There is limited knowledge of how learning unfolds in practice when such training is experienced as insufficient, particularly in municipal healthcare services. This qualitative study examined learning processes during the implementation of a new EHR system in a municipal healthcare institution in Central Norway. Data was generated through interviews and observation, and was analyzed thematically. Participants experienced formal training as poorly aligned with their digital competencies and everyday clinical work. Limited time and staffing further constrained participation in formal training and follow-up. Alongside formal training, employees engaged in peer-based learning practices embedded in everyday work, described as 'shoulder-to-shoulder' learning. These practices became particularly important due to limited time and staffing, enabling rapid problem-solving and mutual support, while also reinforcing shared responsibility for learning. Rather than merely compensating for inadequate training, shoulder-to-shoulder learning emerged as an important adaptive practice that supported problem-solving and collaboration during EHR implementation. Learning to use EHR systems in municipal primary care should be understood as a socially embedded and ongoing process. While formal training may provide initial orientation, implementation strategies should also recognize and support peer-based learning practices that support ongoing learning and collaboration during periods of organizational change.

This study investigated the diagnostic accuracy of AI-assisted diabetic retinopathy screening in primary care, using ophthalmologist-led screening as the reference standard. Patients with type 2 diabetes attending routine appointments at 10 primary care clinics underwent AI-assisted screening, followed by re-screening at an ophthalmology clinic. The quality of fundus images captured in primary care was independently assessed, and diagnostic accuracy was evaluated by comparing AI-assisted results with ophthalmologist results, including sensitivity, specificity, PPV, NPV, and AUC. Two analyses were conducted: one including all images and one excluding those of poor quality. Among 183 patients (336 images), 18.6% of images were classified as poor quality. When all images were included, the AI-assisted screening achieved a sensitivity of 73.7%, specificity of 90.2%, PPV of 31.1%, NPV of 98.3%, and AUC of 0.82. Excluding poor-quality images improved sensitivity to 80.0%, NPV to 98.7%, and AUC to 0.84. Additional ocular findings unrelated to diabetic retinopathy were observed in 96 patients, including confirmed or non-specific signs of glaucoma, cataract, age-macular degeneration, benign nevus and reduced visual acuity. AI-assisted screening in primary care shows potential for clinical application, but further validation in larger populations and improvements in image quality are needed before clinical implementation.

To explore experiences and challenges faced by regional and municipal health care leaders during the COVID-19 pandemic, with a focus on primary health care and care of older adults. A longitudinal qualitative study based on two rounds of semi-structured interviews 2-3&#x2009;months apart. Fifteen health care leaders strategically recruited from regions and municipalities across Sweden. The first interviews took place in November-December 2020, the second in January-March 2021. Four themes were identified. The first captured the challenge of navigating uncharted territory during an unprecedented crisis. The second addressed ethical dilemmas arising from public health priorities. The third highlighted the growing significance and evolving role of infection prevention and control. Finally, the fourth illustrated how initially productive and solution-oriented local collaboration and communication gradually gave way to tensions and conflicting responsibilities. In the early phases of the pandemic, the Swedish Public Health Agency's leadership and measures were generally appreciated, although the initial response was widely perceived as slow and insufficient. The high mortality among older adults was regarded as a major failure, raising ethical concerns and exposing tensions in collaboration between actors. Pandemic work was experienced as exhausting yet meaningful, and the field of infection prevention and control gained increased recognition and status. Some distinctive features of Sweden's pandemic response - such as decentralised decision-making and an emphasis on individual responsibility - may have been shaped by the constitutional prohibition of ministerial rule and the substantial autonomy granted to regional and local authorities.

Cost pressures and limited access challenge the sustainability of Finnish primary care. Multidisciplinary team (MDT) models have been introduced, but evidence on cost and quality in Nordic settings remains limited. To describe healthcare costs and glycaemic control in primary care centres implementing an MDT model versus usual care. This quasi-experimental study included 11,124 patients from five intervention and three control health centres in Espoo, Finland. The MDT model redistributed tasks between nurses and physicians, emphasising remote consultations and proactive management. Retrospective data from primary and secondary care electronic health records (2021-2023) were analysed. Outcomes were annual per-patient costs (&#x20ac;) and the proportion of type 2 diabetes patients with HbA1c >53 mmol/mol. Differences over time were examined using regression models. Baseline costs (2021) were similar between groups. Costs increased in both groups, but by 2023 combined per-patient costs were lower in MDT centres (4902 &#x20ac;) than in controls (6213 &#x20ac;). Primary care costs decreased slightly in intervention centres and increased in controls. Secondary care costs rose in both groups, with a steeper increase observed in control centres. Intervention centres showed a shift toward nurse-led and remote contacts with fewer physician visits. Glycaemic control remained stable in both groups. No clear differences were observed in continuity of care or avoidable hospital admissions. MDT implementation was associated with lower cost growth over three years without compromising glycaemic control.

Acute patients in Norway can access specialist services through various pathways, with primary care services having a gatekeeping role. Although national data show declining acute specialist contacts, some emergency departments report increasing visits. This study examined national trends in acute specialist contacts following primary care visits. This registry-based cohort study included all Norwegian citizens from 2012 to 2021. We obtained information on patients' contact with primary care (general practitioner (GP) service and out-of-hours service) before an acute specialist contact. Acute specialist contacts occuring within 10 h of a primary care contact were considered referrals. Incidence rates were estimated using Poisson regression. Among 12.2 million acute specialist contacts, 21.8% had a preceding out-of-hours service contact, 19.2% had a preceding GP service contact, and 58.9% had no prior primary care contact. From 2012 to 2021, the incidence rate of acute specialist contacts following a primary care contact increased by 18.5% (95% CI: 17.9-19.1), from 91.8 to 109.3 per 1,000 person-years. This trend was observed across all demographic groups, and for both admissions and outpatient visits. The increase was most pronounced for referrals following the out-of-hours service (46.6 to 59.3 per 1,000 person-years), while GP service referrals remained stable. Acute specialist contacts declined over time, while the proportion and incidence rate of those following a primary care contact increased, particularly following out-of-hours services. The consistent trend across demographic groups suggests that changes in healthcare organisation and service use, rather than population changes, are contributing to the observed trend.

Despite limited evidence supporting the long-term effectiveness of opioid therapy and existing recommendations on multi-disciplinary treatment, patients with chronic non-cancer pain (CNCP) continue to receive opioids. In Sweden, most prescription renewals for CNCP are issued by general practitioners (GPs). To explore GPs' experiences with and understanding of opioid prescribing for CNCP and their views on multi-disciplinary collaboration. Semi-structured interviews were conducted with GPs and one GP-trainee in Region Uppsala, Sweden (February-June 2022). Topics included long-term opioid treatment (LTOT), opioid tapering, prescription renewal and multi-disciplinary collaboration. The interviews were recorded, transcribed and thematically analyzed. Twelve participants including one GP trainee with a mean experience of 13&#xa0;years were involved. Two main themes were developed. (1) To endure the ethical conflicts of opioid prescribing practices, where the GPs negotiated ethical conflicts arising in the intersection between patient needs, personal values and clinical guidelines regarding LTOT. (2) The last resort, where the GP's role was conceptualized through the lens of systemic healthcare structures, perceived patient demands, expectations from fellow healthcare providers and the internal expectations held by themselves. GPs experienced moral distress prescribing opioids and reinforced stigma toward patients with CNCP and LTOT. These dynamics hinder treatment reassessment and biopsychosocial evidence-based care. Perceived expectations of GPs as the 'last resort' may perpetuate opioid use and impede collaborative care with the patient and multi-disciplinary teams. Opioid prescribing involves significant ethical dilemmas for general practitioners (GPs).General practitioners face challenges balancing opioid risks with patient expectations and work load.Tapering long-term opioid therapy (LTOT) is regarded as a time-intensive process and is often deprioritized.The identity of the GP as a comprehensive healer is challenged within the context of chronic non-cancer pain (CNCP) and opioid prescribing.General practitioners infrequently utilize multi-disciplinary approaches for the care of patients with CNCP and LTOT.

Post COVID-19 condition remains a complex and challenging issue, with diverse manifestations, despite accumulating research and clinical experience. Dyspnea is one of the most common symptoms reported in post COVID-19 condition. Cardiopulmonary exercise testing (CPET) offers a cohesive assessment of dyspnea and exercise limitations. The Nijmegen questionnaire is a form for assessment of dysfunctional breathing. The aim was to explore relationships between self-reported post COVID-19 respiratory symptoms, assessed by Nijmegen questionnaire, and the results of a 6-minute walk test (6MWT) and CPET, in patients with mild primary infection of COVID-19, managed within primary healthcare. A total of 15 participants with long-term dyspnea after a mild COVID-19 infection were prospectively included at primary healthcare facilities between July 2021 and April 2022. At inclusion, all subjects performed a 6MWT and answered the Nijmegen questionnaire. All subjects underwent CPET within 4&#x2009;months of study inclusion. We estimated correlations between Nijmegen score (both total score and a subset of the questionnaire focusing on respiratory symptoms), and the 6MWT and CPET derived variables, respectively. Nijmegen scores (both total and particularly a respiratory subset) were inversely correlated to 6MWT walking distance, but not to spirometric parameters. Subjects with more self-reported symptoms had higher end-tidal O2 and lower end-tidal CO2, indicating mild hyperventilation. Nijmegen scores also correlated with CPET variables reflecting breathing pattern. Nijmegen score was associated with CPET variables and walking distance at 6MWT. Post COVID-19 condition could be associated with mild hyperventilation, also in subjects without overt dysfunctional breathing pattern.

To explore the critical factors that shape the potential for co-creating and implementing a virtual department for home-based healthcare in a rural municipality. A qualitative case study was conducted in a rural municipality in Northern Norway. Data were collected through semi-structured interviews, focus groups, and co-creation workshops involving healthcare leaders, frontline staff, service users and relatives, and representative from the pensioners' federation. Thematic analysis was applied to identify organisational, contextual, and cultural factors influencing digital transformation. While the co-creation of virtual department for home-based healthcare showed potential for piloting, readiness for full implementation was limited. Six critical factors were identified: structural readiness, digital competence, technology in practice, cultural change, autonomy and care, and motivation and dedication. These factors highlight the importance of organisational culture, workforce capacity, and stakeholder engagement in shaping readiness for responsible digital transformation. Digital transformation holds potential for addressing healthcare challenges in rural municipalities, but success depends on more than technological efficacy. Effective coordination between bottom-up and top-down approaches is required to ensure responsible and sustainable transformation of primary healthcare services.

Evidence of (informal) family caregivers' probability for major mental disorders remains limited. This study aimed to examine the association between high-intensity informal caregiving and major mental disorders using register-based data. This study included all recipients of the family caregiver's allowance in Finland in 2012 (n&#xa0;=&#xa0;42,256) and matched controls (n&#xa0;=&#xa0;83,618). Information on diagnoses of mental disorders treated in hospitals or specialized healthcare settings was obtained from the National Care Register for the period 2012-2017. Overall, 5036 (11.9%) caregivers received at least one diagnosis of a major mental disorder. Caregivers exhibited a lower likelihood of major mental disorders compared to controls; however, from youth to age 70, caregivers were more likely to experience a major mental disorder compared with controls. Caregivers had a higher incidence rate ratio (IRR) for major psychiatric conditions, particularly depressive and mood disorders (IRR 1.33, 95% confidence interval [95% CI] 1.26-1.41) and anxiety-related disorders (IRR 1.37, 95% CI 1.29-1.46). Male caregivers had a higher IRR of mental and behavioral disorders related to psychoactive substance use compared with female caregivers (IRR 3.04, 95% CI 2.66-3.47). By contrast, male caregivers had a lower IRR of depressive and mood disorders than female caregivers (IRR 0.74, 95% CI 0.66-0.82). This study enhances our understanding of family caregivers' likelihood for specific mental disorders. Improved knowledge of these probabilities may facilitate the development of proactive strategies to protect caregivers' mental health and coping capacity before clinically significant problems emerge.

This article explores how female migrant healthcare workers experience recognition in Norwegian nursing homes. Norway faces a growing shortage of healthcare workers due to an ageing population, and many migrant women enter this predominantly female labour market sector. The study employed ethnographic fieldwork guided by a phenomenological approach. Data were collected through interviews with 24 migrant women employed in two municipal nursing homes, alongside participant observation over five weeks during 2023-2024. The participants, from Africa, Asia, Latin America, and non-Scandinavian Europe, had lived in Norway for three to over 20&#x2009;years. Data were analysed using reflexive thematic analysis. The first theme,&#x202f;Finding a Way In: Navigating Expectations, explores the challenges these women face in establishing their professional identities. Despite relevant qualifications, many experience diminished professional status, limited recognition, and restricted career development opportunities. Communication barriers and inadequate social integration also influence their daily work experiences. The second theme,&#x202f;Building Trust and Confidence at Work, examines trust-building through task performance and emotional engagement, highlighting that structural barriers and insufficient support hinder their development. Structural barriers, constrained interpersonal dynamics, and the nature of care work as affective labour often led to unrecognised contributions. Addressing these challenges requires both structural reforms and a cultural shift in how care work and those who perform it are valued.

To assess how physiotherapy contact frequency relates to clinical outcomes in patients with musculoskeletal disorders across prognostic groups, and how outcomes are associated with future healthcare costs and disability pension. Cohort study linking clinical data from the FYSIOPRIM primary care physiotherapy cohort (12-month follow-up) with national registry data on healthcare use, costs, and socioeconomic factors. 1475 patients were included in FYSIOPRIM at baseline, 671 provided data on all covariates and 12-month outcomes and were included in the analysis. Comparing low and high physiotherapy use during a 12 month follow-up period (High use: Median or higher (9+ contacts)). Patients were categorized into good, medium, and poor clinical prognosis based on seven baseline clinical factors. Global Perceived Effect (GPE) at 12 months, high healthcare costs (&#x2265;95th percentile two years post-FYSIOPRIM), and disability pension (1-3 years post-FYSIOPRIM). High physiotherapy use was associated with improvement in GPE in patients with poor prognosis (OR 4.04, 95%CI 1.56-10.50) but not for good or medium prognosis. Improvement on GPE was associated with lower odds of high future healthcare costs (OR 0.27, 95%CI 0.13-0.58) and disability pension (OR 0.06, 95%CI 0.01-0.53). Patients with poor prognosis may benefit from more physiotherapy contacts, while those with better prognosis may require fewer contacts. Tailoring treatment intensity to prognosis may support more efficient resource allocation and support long-term societal benefits through reduced healthcare costs and disability risk.