title: Reduced utilization and cost of primary care clinic visits resulting from self-care education for patients with osteoarthritis of the knee.
abstract: OBJECTIVE
  To determine the extent to which the cost of an effective self-care intervention for primary care patients with knee osteoarthritis (OA) was offset by savings resulting from reduced utilization of ambulatory medical services.
  
  
  METHODS
  In an attention-controlled clinical trial, 211 patients with knee OA from the general medicine clinic of a municipal hospital were assigned arbitrarily to conditions of self-care education (group E) or attention control (group AC). Group E (n = 105) received individualized instruction and followup emphasizing nonpharmacologic management of joint pain. Group AC (n = 106) received a standard public education presentation and attention-controlling followup. A comprehensive clinical database provided data concerning utilization and cost of health services during the following year.
  
  
  RESULTS
  Only 25 subjects (12%) were lost to followup. The 94 subjects remaining in group E made 528 primary care visits during the year following intervention, compared with 616 visits by the 92 patients remaining in group AC (median visits 5 versus 6, respectively; P < 0.05). Fewer visits translated directly into reduced clinic costs in group E, relative to controls (median costs [1996 dollars] $229 versus $305, respectively; P < 0.05). However, self-care education had no significant effects on utilization and costs of outpatient pharmacy, laboratory, or radiology services over the ensuing year. The cost per patient to deliver the self-care intervention was estimated to be $58.70.
  
  
  CONCLUSIONS
  Eighty percent of the cost of delivering effective self-care education to the knee OA patients in this study was offset within 1 year by the reduced frequency and costs of primary care visits. For >50% of patients receiving the intervention, the savings associated with fewer primary care visits exceeded the cost of self-care education.
authors.affiliation: Rheumatology Division, Indiana University School of Medicine, Indianapolis 46202-5103, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Mazzuca
authors.forename: K D
authors.initials: KD
authors.lastname: Brandt
authors.forename: B P
authors.initials: BP
authors.lastname: Katz
authors.forename: M P
authors.initials: MP
authors.lastname: Hanna
authors.forename: C A
authors.initials: CA
authors.lastname: Melfi
mesh_terms: D000368:Aged; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D007196:Indiana; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D020370:Osteoarthritis, Knee / Q000191:economics*; D010044:Outpatient Clinics, Hospital / Q000191:economics* / Q000706:statistics & numerical data*; D010353:Patient Education as Topic / Q000191:economics*; D011320:Primary Health Care / Q000191:economics* / Q000706:statistics & numerical data*; D012648:Self Care / Q000191:economics*; D012680:Sensitivity and Specificity