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. 2009 Dec 15;61(12):1694-703.
doi: 10.1002/art.24897.

Ambulatory visit utilization in a national, population-based sample of adults with osteoarthritis

Miriam G Cisternas  1 , Edward Yelin, Jeffrey N Katz, Daniel H Solomon, Elizabeth A Wright, Elena Losina
Affiliations

Ambulatory visit utilization in a national, population-based sample of adults with osteoarthritis

Miriam G Cisternas et al. Arthritis Rheum. .

Abstract

Objective: To estimate the proportion of adults with osteoarthritis (OA) seeing various medical providers and ascertain factors affecting the likelihood of a patient seeing an OA specialist.

Methods: We used data from the Medical Expenditures Panel Survey, a stratified random sample of the noninstitutionalized civilian population. We classified adults as having symptomatic OA if their medical conditions included at least 1 occurrence of the International Classification of Diseases, Ninth Revision Clinical Modification, codes 715, 716, or 719, and if they reported joint pain, swelling, or stiffness during the previous 12 months. For the purpose of our analysis, we defined rheumatologists, orthopedists, and physical therapists as OA specialists. We first estimated the proportion of OA individuals seen by OA specialists and other health care providers in a 1-year period. We then used logistic regression to estimate the impact of demographic and clinical factors on the likelihood of an individual seeing an OA specialist.

Results: A total of 9,933 persons met the definition of OA, representing 22.5 million adults in the US. Of these persons, 92% see physicians during the year, 34% see at least 1 OA specialist, 25% see an orthopedist, 11% see a physical therapist, and 6% see a rheumatologist. Higher educational attainment, having more comorbidities, and residing in the northeastern US are significant positive predictors for a patient seeing an OA specialist. Significant negative predictors for seeing an OA specialist are being unmarried but previously married and having no health insurance.

Conclusion: Most adults with OA do not visit OA specialists. Those without insurance and with lower levels of education are less likely to see these specialists.

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Figures

Figure 1
Figure 1
Percent and 95% CIs of Persons with OA in MEPS Seeing Various Medical Specialties in an Ambulatory Setting over a One-Year Period, U.S., 2002–2005 Respondents can be seen by multiple specialties. NP=Nurse Practitioners, PA=Physician’s Assistants. 95% CIs are all within ±2% of the estimate. The MEPS sample reflects the non-institutionalized civilian population; analyses limited to individuals age 18 and over.
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