Outpatient and home visits

DEFINITIONS

Age group — in health care statistics a child is considered to be a person aged 0 to 14 years, while an adult is a person aged 15 years and older.

Calendar adjustment of a time series — a process of determining and elimination of the calendar component.

Calendar component — the part of seasonal component which is related to the calendar used in the country: fixed and moving holidays, leap years and other calendar-related phenomena.

County — location of health care service provider. It is classified according to the Classification of Administrative and Settlement Units of Estonia (EHAK) (see classifications). Until 2017, data by the counties is distributed by the administrative division that existed before administrative reform (October 2017). Data starting from 2018 is distributed by new administrative division.

Dental care outpatient surgery — a surgical procedure on teeth and gums (excluding tooth extraction), which is carried out during an outpatient visit.

Dental care visit — all visits to the dentist, including surgical visits, but except dental hygienist, prosthetic and orthodontic visits.

Health care provider or health care facility — a legal person whose principal or ancillary activity is to provide health care services. Health care providers (except family doctor's offices) must have an activity licence issued by the Health Board (Health Care Board until 1 January 2010).

Health care service — activities of health care personnel (doctor, dentist, nurse, midwife), aimed at preventing, diagnosing or curing a disease, an injury or poisoning, at alleviating human suffering, at preventing the state of health of a patient from worsening or exacerbating and at improving the patient’s health.

Independent work of the nursing staff — independent consultation of a patient or a home visit on the part of a nurse or a midwife.

Number of patients who did not need dental treatment — persons who visited a dentist, but who did not need dental treatment during the year.

Nursing personnel — persons who have completed a programme of basic nursing education (at least 3 years), i.e., qualified nurses and midwives.

Outpatient health care service, or outpatient care — outpatient health care service, when a patient’s visit to a health care institution is confined to a few hours and accommodation overnight in an inpatient facility is not needed.

Outpatient operations — a surgical procedure to teeth and gums that is done during an outpatient visit.

Outpatient consultation — a general term meaning the outpatient contact, including an outpatient visit to the doctor’s or nurse’s office and home visits, excluding contacts by phone.

Outpatient visit — outpatient contact of a person who needs medical consultation during the doctor’s or nurse’s working time in the office.

Periodontal treatment visits — visits that include treatment of gingivitis and periodontal diseases (ICD-10 code K05).

Seasonal adjustment of a time series — a process of determining and elimination of the seasonal component. Seasonality can be caused by natural factors, administrative conditions, and social and cultural traditions.

Seasonal component — the part of the variations in a time series representing intra-year fluctuations that are more or less stable year after year with respect to timing, direction and magnitude.

Trend — a timeline that is cleared of seasonality and random effects, and which shows the direction of the time series.

Type of provider of health care services — health care providers are divided into the following types: hospitals, family doctor's offices, specialist health care providers, dental care providers, emergency medical care providers, rehabilitation care providers, diagnostics providers, nursing care providers and other providers (see classifications).

Working-day adjustment of a time series — a process of determining and elimination of the working-day effect; that is to achieve a seasonally adjusted series, the values of which are independent of the length of month/quarter and composition of weekdays (the number of Mondays, Tuesdays etc., and the number of working and weekend days).

METHODOLOGY

The purpose of collecting and producing outpatient care statistics is to get an overview of the volume of work done by health care providers providing different services respective to their place of operation.

Data is collected from all legal persons providing outpatient health services where physicians and nursing personnel carry out outpatient visits and home visits, except from those that only provide an emergency medical care service or health services in schools. Consultations provided by phone and e-mail are not collected. The grounds for data collection are the Health Services Organisation Act and the regulation of the minister responsible for this field enacted based on the Act, “Requirements for the preparation of reports on health care statistics and health care economic, the data set and the procedure for the submission”. Reports are submitted online to the National Institute for Health Development through the health care statistics report collection environment A-veeb.

Outpatient care statistics of using health care services are based on the following reports:

The statistics of visits and home visits of physicians and nursing personnel are collected with the report “Outpatient consultations” pursuant to the list of occupations that has been prepared on the basis of the “List of specialities of physicians” and “List of nursing specialities”. 37 occupations of physicians and 3 occupations of nursing personnel have been differentiated. In general, dental care providers do not submit the report “Outpatient consultations”, except in the case there are physicians of another group of occupation (e.g. an oral-maxillofacial surgeon) working in the facility who also provide outpatient visits or home visits.

Until 2016 (incl.), two different report forms were used to collect the data of outpatient consultations of physicians and nursing personnel – the quarterly report “Physicians’ outpatient visits and home visits” was used to collect data for publishing short-term statistics and the table “Outpatient care” of the annual report “Health care provider” was used to obtain additional data. For example, up until 2016, the number of phone consultations registered by a physician was also collected, which is an important part in the work of a physician (including a family doctor). In addition, among outpatient visits of physicians, illness-related visits were distinguished from other prophylactic visits (receiving a medical certificate, vaccination, monitoring of a healthy child or a pregnant person, etc.). The collection of this data was terminated with the establishment of the new annual report. Distinguishing illness-related consultations from prophylactic consultations required a lot of resources from health care providers and there is no significant difference between them for statistical purposes. The collection of phone consultations was terminated because it is possible to request data about family doctors’ and nurses’ phone consultations from the Estonian Health Insurance Fund and the data of medical specialists’ and nurses’ phone consultations collected by the report did not have a high enough quality – they lack unified coding and definitions.

Up until 2008, the data of all nursing personnel was published together; as of 2009, the outpatient visits and home visits of home nurses, midwives and occupational health nurses have been presented separately from the total number. As of the report form valid from 2017, the consultations of family and home nurses and midwives have been distinguished.

The decline in the outpatient visits of family doctors in 2017 (11%) compared to the previous year is linked to the technical changes in the information system of family doctors. The repeat prescription marking was changed in the information system; when the issuing of a repeat prescription was previously coded as an individual visit, then as of 2017, they have been coded as phone consultations (codes 9002 and 9018 in the list of health care services of the Estonian Health Insurance Fund, respectively). According to the data of the Estonian Health Insurance Fund, the volume of phone consultations increased two times in 2017.

Outpatient visits and home visits of dental care specialities by service type are collected with the annual “Dentist’s report”. The report is prepared by both independent dental care providers as well as dental care, denture and orthodontics departments/clinics within other care providers. In table 1 of the report, “Dentist’s outpatient visits and home visits”, data is collected on the total number of outpatient consultations of all dental care specialities (dentists, denture specialists, orthodontists and oral-maxillofacial surgeons working at independent dental care providers) of adults and children made during the year. The data is collected on two age groups: children (0–14 years old) and adults (15 and older).

Outpatient visits and home visits of oral-maxillofacial surgeons have been published in tables AV10, AV11, AV12 and AV13 of the Health Statistics and Health Research Database as follows:

In 2017, the number of outpatient visits of oral-maxillofacial surgeons increased by half compared to 2016. A possible reason for the increase in the number of outpatient visits may be a change in the methodology of data collection – the data on consultations of dental care specialities was previously collected on the same report form where not all dental care providers differentiated consultations of oral-maxillofacial surgeons that were to be marked on a separate row from the total number of dental care consultations. The consultations by oral-maxillofacial surgeons are distinguished more clearly with the data collection method in force since data is collected with two different report forms.

About seasonal correction (data 2008–2016)

Seasonal correction of a timeline is the process of determining and elimination of the seasonal component. Seasonality can be caused by natural factors, administrative conditions, and social and cultural traditions.

Seasonal adjustment enables comparisons between time periods and interpreting the development of the series with different seasonal patterns. Seasonal adjustment is important when observing changes in two conterminous periods (month/quarter), because two periods that follow each other directly are usually characterized by strong seasonality. Only tendencies of slope and their expansion rate can be described when we talk about seasonally adjusted time series. The number of one element of adjusted time series does not characterize reality nor does it represent a real number. Thus, when comparing the same period of two different years, it is suggested to use seasonally unadjusted data.

For seasonal and working-day adjustment of time series Eurostat’s free software DEMETRA 2.04 and its integrated model TRAMO/SEATS that is based on parametric methods is used. The model is updated once a year on average. The parameters of time series are updated retroactively for 4 years since last observation. Additional information about seasonal adjustment can be found here (in Estonian).

CLASSIFICATIONS

Classification of Administrative and Settlement Units of Estonia (EHAK)

This classification is used upon submission of regional statistics. Regional health care statistics are submitted by 15 counties. Information about Tallinn and Tartu is submitted separately. Until 2017, data by the counties is distributed by the administrative division that existed before administrative reform (October 2017). Data starting from 2018 is distributed by new administrative division. This classification system is available on the webpage of the Statistics Estonia in the Classifications section.

List of specialities of physicians

List of Specialities of Physicians (in Estonian) decree, issued by the Minister of Social Affairs on 28 November 2001, serves as the basis for the classification of doctor’s and dentist’s specialities.

List of nursing specialities

List of Nursing Specialities (in Estonian) decree, issued by the Minister of Social Affairs on 11 June 2001, serves as the basis for the classification of nursing specialities.

PUBLICATIONS

Anderson E, Eigo N, Kirpu V, Panov L, Rätsep M, Sokurova D, Väärsi K. Reasons for visiting family doctors’ offices in 2017. Tallinn: National Institute for Health Development; 2018. Analysis is available here in pdf-format

Anderson E. Midwives’ Outpatient Visits 2009–2016. Tallinn: National Institute for Health Development; 2017. Analysis is available here in pdf-format

Anderson E, Panov L. Family doctor’s offices’ outpatient consultations data in the e-health system, 2015. Tallinn: National Institute for Health Development; 2017. Analysis is available here in pdf-format

National Institute for Health Development of Estonia, The National Health Service of Latvia, Health Information Centre, Institute of Hygiene, Lithuania. Health in the Baltic Countries 2015. Tallinn: National Institute for Health Development; 2017. Report is available here in pdf-format

Anderson E. Independent outpatient visits of nurses 2005–2015. Tallinn: National Institute for Health Development; 2017. Analysis is available here in pdf-format

National Institute for Health Development of Estonia, The National Health Service of Latvia, Health Information Centre, Institute of Hygiene, Lithuania. Health in the Baltic Countries. 2014. Tallinn: National Institute for Health Development; 2016. Report is available here in pdf-format

Anderson E. Physician’s outpatient and home visits 2004–2014. Tallinn: National Institute for Health Development; 2016. Analysis is available here in pdf-format

LINKS

Anderson E. Quality report on the statistics of outpatient consultations. Tallinn: National Institute for Health Development; 2018. Report is available here in pdf-format

CONTACT

Eva Anderson

Department of Health Statistics

National Institute for Health Development

Phone: +372 659 3806

E-mail: Eva.Anderson[at]tai.ee

 

Dental visits data contact

Kai.Maasoo

Department of Health Statistics

National Institute for Health Development

Phone: +372 659 3821

E-mail: Kai.Maasoo[at]tai.ee

 

 

Updated: 10.10.2019