A. Dahlberg, T. Kaartinen, S. Jukarainen, P. Orre
Background: Chat-based digital clinics are increasingly integrated into public primary care. This study evaluates a 24/7 chat-based digital clinic integrated into Harjun terveys, Paijat-Hame, Finland. Methods: Data from 1,580,838 primary care encounters recorded between 2019 and 2025 were used to examine care patterns following the digital clinic's introduction.. Results: Primary care coverage (residents with [≥]1 public primary care encounter) fell from 39.2% in 2019 to 35.7% in 2020, consistent with pandemic-related suppression, before stabilising between 44% and 48% from 2022 onwards (44.2% in 2025). Utilisation rose from 1,222 encounters per 1,000 residents in 2020 to 2,058 by 2025. Digital encounters grew from 15.2% of all primary care encounters in 2021 to 25.8% in 2025. Digital users were younger (mean age 33.2 vs. 55.1 years; P<.001) and had lower crude comorbidity prevalence (CCI [≥] 1: 13.1% vs. 33.6%); after age and sex standardisation this narrowed to 22.8% vs. 27.5% (adjusted OR 0.78, 95% CI 0.75-0.81). Common physician-level diagnoses included conjunctivitis, acute cystitis, and prescription renewals. Same-day escalation to a physician occurred in 18.0% of digital clinic encounters; excluding care already scheduled beforehand, 32.6% of patients had a further contact of any reason within 14 days and 42.4% within 30 days. Conclusions: Primary care coverage and the digital share of encounters both rose alongside the digital clinic's introduction. Most encounters were concluded at nurse level without a planned follow-up, and approximately 60% of seven-day pathways remained within the digital channel. Where patients contacted the service again within 30 days, a repeat digital encounter was the most common route and an in-person appointment the first return contact for fewer than one in ten patients; contacts were counted irrespective of reason.