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

Objective. To examine the predictive ability of a wide array of measures of disease severity in explaining Dutch and German patterns of health service s utilization during a 2-year period. Methods. Slightly over 200 rheumatoid arthritis (RA) patients, 136 from a D utch and 98 from a German outpatient clinic, supplied information on sympto m and functional status, global health, and emotional and social functionin g 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 c onsultations, hospitalization, and referrals for surgery and physical thera py during the previous period. Major determinants of use were studied with multivariate analyses. Results. German patients reported more frequent physician contacts than Dut ch patients, but the volume of surgery, hospital admissions, and referrals for physical therapy did not differ between the two countries. In a hierarc hical regression, the consultation rate rr as directly associated with pain qualify and global health. Markers of RA progression were related to surge ry and the latter to volume to in hospital care. Fatigue severity and physi cal disability predicted referrals for physical therapy. patient self-manag ement activities rr ere only weakly associated with disease severity variab les. Conclusion. The activity and damage components of RA were related to the se parate components of total health sen ice utilization. Disease activity was the prime determinant of physician services used, and RA progression the d eterminant of surgical interventions and hospitalization.