A program for the systematic detection and management of arthritis disability was developed for an urban population. A survey identified 601 persons with rheumatic disability in a population of 9,500-10,550. Seventy-eight persons were evaluated and given recommendations. An ombudsman assisted the clients in obtaining health services and coordinated care. An evaluation 6-8 months later showed increased utilization of and referrals to relevant services but, on the whole, tittle improvement in functional capacity was noted. However, the small numbers do not permit more definite conclusions.The present health system does not adequately address the unique clinical features of chronic arthritis. The general physician encounters the majority of per-
A pilot community program for arthritis disability was developed for three census tracts in Jamaica Plain. An inexpensive case-finding phone and mail survey carried out by community volunteers identified persons with arthritis disability at a unit cost of $8.46. Persons identified had a variety of problems: undiagnosed and treatable arthritic conditions such as psoriatic arthritis and tophaceous gout. Some were ignorant about the risks and benefits of joint replacement surgery, about rehabilitation intervention, or about existing community resources such as transportation services. Persons with impaired function from arthritis were assessed by a rehabilitation team and were given specific management recommendations. A trained ombudsman assisted the clients in getting health care or community services. An experimental design was used to evaluate the advocacy program in improving function and to document patterns of utilization. The results suggest that persons who received the intervention were more likely to have improved their function status, but the numbers are too small to permit definite conclusions.
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