title: Use of physician services in a population-based cohort of patients with polymyalgia rheumatica over the course of their disease.
abstract: OBJECTIVE
  To describe the use of generalist and rheumatologist services in a population-based cohort of patients with polymyalgia rheumatica (PMR) and to identify predictors of rheumatology care.
  
  
  METHODS
  We identified all incident cases of PMR among residents of Olmsted County, Minnesota between 1970 and 1999. Patients were followed for a maximum of 5 years after their incidence date. Logistic regression and zero-inflated Poisson regression models were used to assess the association between rheumatology care and age, sex, giant cell arteritis (GCA), PMR relapses, corticosteroid complications, comorbidity, and various laboratory findings, adjusting for the total number of visits.
  
  
  RESULTS
  Of the 364 incident cases of PMR eligible for this analysis, 67% were women and the mean age at incidence was 73 years. Over a mean followup of 4.1 years, individuals in this cohort utilized a total of 5,108 physician office visits and 2,015 telephone calls. The mean number of generalist and rheumatologist visits per person-years of follow-up during the first year of PMR was 7.02 and 2.15, respectively. Thereafter, there was a steady decline in both generalist and rheumatologist visits. One hundred forty-four (40%) patients had no rheumatologist visits and 102 (28%) had only 1 rheumatologist visit, mostly for diagnostic confirmation. Men and patients with several comorbid conditions were significantly more likely to be seen by rheumatologists (P < 0.001). However, once referred, women, older patients, and those with GCA, PMR relapses, and corticosteroid complications had significantly more rheumatologist visits (P < 0.001).
  
  
  CONCLUSIONS
  The use of physician services in PMR is considerable. Generalists provide the large majority of care. Rheumatologist involvement is generally limited to diagnostic confirmation and management of complications. The relative paucity of rheumatology care following the period of diagnosis may represent an opportunity for improving the care of patients with PMR.
authors.affiliation: Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
authors.forename: Hilal Maradit
authors.initials: HM
authors.lastname: Kremers
authors.forename: Megan S
authors.initials: MS
authors.lastname: Reinalda
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Crowson
authors.forename: Alan R
authors.initials: AR
authors.lastname: Zinsmeister
authors.forename: Gene G
authors.initials: GG
authors.lastname: Hunder
authors.forename: Sherine E
authors.initials: SE
authors.lastname: Gabriel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005194:Family Practice; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D010820:Physicians / Q000706:statistics & numerical data*; D011111:Polymyalgia Rheumatica / Q000628:therapy*; D012219:Rheumatology