Abstract
Purpose: To examine rheumatology subspecialty practice patterns, determinants of referral
to rheumatologists, and utilization of aspiration and injection procedures in a population-based
sample of elderly individuals.
Subjects and Methods: We obtained Medicare physician claims for all visits to rheumatologists
among beneficiaries aged 65 years and older in Colorado, Massachusetts, and Virginia
in 1993, and for visits to all providers by patients with coded diagnoses of rheumatoid
arthritis (RA) and systemic lupus erythematosus (SLE). We examined variations in visit
frequency and aspiration/injection procedures, and we analyzed determinants of referral
to a rheumatologist for RA or SLE.
Results: In 1 year, 144,797 visits were made to rheumatologists by 38,443 patients
in the three states. An inflammatory disorder was coded in 45% of visits and a noninflammatory
disorder in 50%. Half of patients with RA were seen three or fewer times in the year.
For RA and SLE, African Americans were about 60% as likely to be seen by a rheumatologist
as whites. Utilization of rheumatologist services for rheumatoid arthritis and systemic
lupus erythematosus was highest in the state (Virginia) with the lowest per capita
supply of rheumatologists. Among patients with bursitis, tendinitis, and osteoarthritis,
African-American women were more likely to receive an injection or aspiration procedure
than whites or African-American men.
Conclusion: Elderly patients with rheumatologic disorders were seen by specialists
less frequently than recommended by a recent rheumatology manpower survey. African-Americans
with RA and SLE had fewer rheumatology visits than whites.
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Article info
Publication history
Published online: August 16, 2004
Accepted:
June 19,
1998
Received in revised form:
June 19,
1998
Received:
December 17,
1998
Footnotes
☆Supported by grants from the American College of Rheumatology Research and Education Fund, the Arthritis Foundation, and NIH Grant # AR36308.
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© 1998 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
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