Consumption of medical resources and outcome of shoulder disorders in primary health care consulters

Abstract

BackgroundShoulder disorders are common problems in primary health care. The course of disease of patients consulting for a new episode of a shoulder problem has been thought to be benign. In this prospective cohort study, we assessed the one-year consumption of medical resources and clinical outcome of shoulder disorders inclusive of all disease episodes.MethodsAll individuals consulting primary health care for shoulder disorder in a catchment area of more than 120 000 people were included. A composite questionnaire including the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) was used to measure use of resources as well as shoulder pain and function. A follow-up assessment was performed after one year.ResultsA total of 128 individuals responded to the questionnaire. Only 24% of the patients had recovered after one year. Mean shoulder pain (Visual analogue scale, VAS, max 100 mm) decreased from 38.9 mm to 28.6 mm (95% CI -16.3 to -4.2 mm). The ASES score (max 100) improved significantly from 59.9 to 70.2 (95% CI 5.3 to 15.3). Mean one-year consumption of medical resources after the index consultation was 1.5 consultations, 0.5 radiological examinations, and 3.3 visits to physiotherapist. Mean resource-weighted direct costs were €543/patient/year (95% CI €351 to 735).ConclusionsShoulder disorders are often chronic and require a significant amount of resources from the health care system. The clinical outcome of the management of shoulder disorders in our study population including also individuals who have consulted previously for a shoulder problem is notably poorer than the one reported by previous studies on new episodes. However, despite the relatively modest outcome, subjective disability is low.

Risk stratification of patients with shoulder pain seen in physical therapy practice

“…The growing financial demand on the system should facilitate increased focus on efficacy of care. Shoulder disorders are one of the most common musculoskeletal issues that patients see a physician for and the course of the disorder is thought to be rather benign [35]. Despite this assumption, only 24% of patients with shoulder disorders reported being recovered after 1 year [35].…”

“…Shoulder disorders are one of the most common musculoskeletal issues that patients see a physician for and the course of the disorder is thought to be rather benign [35]. Despite this assumption, only 24% of patients with shoulder disorders reported being recovered after 1 year [35]. Medical care after primary care including specialty consultations, imaging procedures and physical therapy (mean of 3.3 visits) reportedly cost $695/patient/year (95% CI $449-$941) [35].…”

Incidence of shoulder pain in 40 years old and over and associated factors: A systematic review

“…In the United States, SP is responsible for 13% of sick leaves and 7 billion US dollars in health care costs per year (Hidalgo-Lozano et al, 2010), while it represents 26% of occupational injuries in France (Bodin et al, 2017). However, these figures probably underestimate the impact of SP, since it is thought that 55% to 67% of people with musculoskeletal pain do not seek medical help (Paloneva, Koskela, Kautiainen, Vanhala, & Kiviranta, 2013). Moreover, with ageing populations and longer careers, the burden of SP can be expected to increase.…”

Rising trends in surgery for rotator cuff disease in Western Australia

“…Increasing rates of surgery for RCD have been reported over the past decade in a number of countries including the USA, [6][7][8] UK, 4 Denmark 9 and Finland, 10 with rising trends associated with concurrent increases in health care costs. [11][12][13][14][15][16][17][18][19][20] Surgical trends, variations in hospital setting, gender, age and associated costs for RCD in Australian populations have not been reported.…”