Rheumatic patients in primary and secondary care: differences in structure of diagnoses and working load within a five-year period.
OBJECTIVE
To compare conditions handled by family doctors and rheumatologists and analyze changes in the distribution of work between primary and secondary care.


METHODS
The study population consisted of patients listed with five family doctors. The number and structure of patients with rheumatic diseases and dynamics of visits were examined on the basis of yearly reports dating from 1999 to 2003. Statistics for 1999-2003 were analyzed to provide a background for data concerning outpatient rheumatic care at the University Hospital. A 2-month survey of all consecutive patients referred to rheumatology outpatient center was performed.


RESULTS
The number of visits per patient to a family doctor has decreased to 3.0 in 2003 while the number of visits of rheumatic patients to family doctors has increased to 5.9. In 2003 rheumatic patients made up 16.9% of all family doctors' patients, while their number of visits constituted 33.5% of the total visits to a family doctor. The share of visits to a family doctor by rheumatoid arthritis patients has decreased, whereas the share of patients with osteoarthritis has increased. Waiting time for a specialist appointment in 2004 does not exceed three weeks. Out of all the patients referred to rheumatologists, 31.2% were patients with rheumatoid arthritis and 10.4% with osteoarthritis. Patients assessed the availability of rheumatologists as excellent in 47% of cases.


CONCLUSIONS
Since a new model of primary health care was implemented, the division of work between primary and secondary care has been rearranged and currently corresponds to the patient structure and available resources in outpatient care.
Kallikorm
Riina
R
Department of Internal Medicine, University of Tartu, Tartu, Estonia. riina.kallikorm@kliinikum.ee
Tender
Mare
M
D004957:Estonia; D006801:Humans; D008511:Medicine; D011320:Primary Health Care / Q000458:organization & administration*; D012216:Rheumatic Diseases / Q000628:therapy*; D013038:Specialization; D016526:Workload