The disease process and utilization of health services in rheumatoid arthritis: The relative contributions of various markers of disease severity in explaining consumption patterns

Abstract

Objective. To examine the predictive ability of a wide array of measures of disease severity in explaining Dutch and German patterns of health services utilization during a 2-year period.Methods. Slightly over 200 rheumatoid arthritis (RA) patients, 136 from a Dutch and 98 from a German outpatient clinic, supplied information on symptom and functional status, global health, and emotional and social functioning at baseline. The patients' rheumatologists provided clinical assessments of functional grade and disease activity. A questionnaire mailed twice at 12-month intervals was the source of retrospective information on physician consultations, hospitalization, and referrals for surgery and physical therapy during the previous period. Major determinants of use were studied with multivariate analyses. Results. German patients reported more frequent physician contacts than Dutch patients, but the volume of surgery, hospital admissions, and referralsfor physical therapy did not differ between the two countries. In a hierarchical regression, the consultation rate was directly associated with pain quality and global health. Markers of RA progression were related to surgery, and the latter to volume of inhospital care. Fatigue severity and physical disability predicted referrals for physical therapy. Patient self-management activities were only weakly associated with disease severity variables.Conclusion. The activity and damage components of RA were related to the separate components of total health service utilization. Disease activity was the prime determinant of physician services used, and RA progression the determinant of surgical interventions and hospitalization.

Predictors of the Use of Physical Therapy Services Among Patients With Rheumatoid Arthritis

“…These individuals were likely to report lower MDHAQ function scores and have more severe disease or more active disease, leading to chronic pain and disability and, in turn, increasing physical therapy service use. 24 Although fatigue is a common complaint among people with RA, particularly during active flares, and has been shown to predict physical therapy service use, 24 we did not identify fatigue as a significant predictor in our model after adjusting for other factors. One possible explanation for the lack of significance of fatigue may relate to the method used to measure fatigue.…”

“…As fatigue is a highly prevalent symptom of RA and is likely associated with physical therapy service use, 24 we included a measure of fatigue in our study. Fatigue was assessed using a VAS for fatigue.…”

Costs and predictors of costs in rheumatoid arthritis: A prevalence‐based study

“…Rheumatoid arthritis (RA) represents the paradigm of chronic inflammatory musculoskeletal disorder with a high prevalence and a progressive clinical course negatively affecting patients' quality of life, function, and life expectancy. Besides the consequences on the health status of individuals, RA has a substantial economic impact on patients, their families, and society (3)(4)(5)(6).…”

Physiotherapeutische Routineversorgung von Patienten mit rheumatischen Erkrankungen – Auswirkungen auf Schmerz, Funktionsfähigkeit und Lebensqualität

“…Es scheint demnach so, das insbesondere die schwerer betroff enen Patienten, also die, welche fr ü her erkranken und schlechtere Verl ä ufe zeigen, krankengymnastische Ma ß nahmen erhielten. Zum gleichen Ergebnis kommt Waltz[39] bei einer Untersuchung von deutschen und niederl ä ndischen Patienten mit rheumatoider Arthritis. Hier war neben dem Schweregrad des Fatigue auch die St ä rke der funktionalen Behinderung ein wichtiger Vorhersagefaktor f ü r eine physiotherapeutische Versorgung.…”