Patterns of Healthcare Use and Disease Burden Among Older Adults in Poland: A Large-Scale Retrospective Study of Primary Care Utilization.

Background: Population aging in Poland has led to rising healthcare needs, but comprehensive evidence on long-term utilization patterns is limited. This study aimed to analyze healthcare use and disease burden among older adults, with particular focus on the impact of the COVID-19 pandemic, including its effects on care pathways, continuity of services, and differences between urban and rural populations. Methods: We conducted a retrospective study using anonymized medical records from a primary healthcare network in Poland between January 2020 and December 2024. The sample included 42,844 patients aged 60 years or older patients aged ≥60 years, with a total of 738,300 consultations. Data on demographics, visit type, prescriptions, referrals, diagnostic tests, and follow up were analyzed using chi-square tests, logistic regression, and nonparametric comparisons. Results: The mean age of patients was 77.5 years (SD 9.4), and 63.7% were women. The mean number of visits in the preceding 12 months was 10.3 (range 0-460). Prescriptions were issued in 56.9% of visits, referrals in 33.5%, and diagnostic tests in 21.4%. Patients with chronic diseases were more likely to receive diagnostic tests than those without (32.4% vs. 21.1%, χ2 = 1570.42, p < 0.0001), but less likely to return within 30 days (23.4% vs. 39.4%, χ2 = 2243.76, p < 0.0001). First visits generated more referrals than follow ups (41.6% vs. 32.9%, χ2 = 1620.51, p < 0.0001). Completed visits were strongly associated with prescription issuance (63.2% vs. 16.4%, χ2 = 1048.76, p < 0.0001). Return analyses showed that patients with more prior visits were significantly more likely to re-engage at 30, 60, and 90 days (all p < 0.0001). Age correlated positively with total number of visits (ρ = 0.136, p < 0.05) with the oldest adults more likely to return at 60 and 90 days. Visit realization decreased during early pandemic phases but increased significantly post-COVID (OR = 1.76, p < 0.001). Psychiatric referrals increased the odds of return within 30 days (OR = 1.42) and 60 days (OR = 1.36). Conclusions: Older adults in Poland demonstrate high healthcare utilization, with patterns shaped by age, chronic disease status, and pandemic-related disruptions. While statistical associations were robust, effect sizes were small, highlighting the need to focus on clinically meaningful differences in planning geriatric care. The findings highlight that COVID-19 acted as a major modifying factor of healthcare engagement, revealing the vulnerability of geriatric care continuity to system-level disruptions.