title: Health service utilization patterns of primary care patients with osteoarthritis.
abstract: BACKGROUND
  To assess factors associated with visits to GPs, orthopaedists, and non-physician practitioners of complementary medicine (alternative practitioners) by primary care patients with osteoarthritis (OA).
  
  
  METHODS
  Cross-sectional survey among 1250 consecutively addressed patients from 75 primary care practices in Germany. All patients suffered from OA of the knee or hip according to ACR criteria. They received questionnaires collecting sociodemographic data, data about health service utilisation, prescriptions, comorbidities. They also included established instruments as the Arthritis Impact Measurement Scale (AIMS2-SF) to assess disease-specific quality of life and the Patient Health Questionnaire (PHQ-9) to assess depression. Hierarchical stepwise multiple linear regression models were used to reveal significant factors influencing health service utilization.
  
  
  RESULTS
  1021 of 1250 (81.6%) questionnaires were returned. Nonrespondents did not differ from participants. Factors associated with health service use (HSU) varied between providers of care. Not being in a partnership, achieving a high score on the PHQ-9, increased pain severity reflected in the "symptom" scale of the AIMS2-SF, and an increased number of drug prescriptions predicted a high frequency of GP visits. The PHQ-9 score was also a predictor for visits to orthopaedists, as were previous GP contacts, a high score in the "symptom" scale as well as a high score in the "lower limb scale" of the AIMS2-SF. Regarding visits to alternative practitioners, a high score in the AIMS -"social" scale was a positive predictor as older people were less likely to visit them.
  
  
  CONCLUSIONS
  Our results emphasize the need for awareness of psychological factors contributing to the use of health care providers. Addressing the revealed factors associated with HSU appropriately may lead to decreased health care utilization. But further research is needed to assess how this can be done successfully.
authors.affiliation: University Hospital Heidelberg, Department of General Practice and Health Services Research; Vosstr, 2, 69115 Heidelberg, Germany. thomas_rosemann@med.uni-heidelberg.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Rosemann
authors.forename: Stefanie
authors.initials: S
authors.lastname: Joos
authors.forename: Joachim
authors.initials: J
authors.lastname: Szecsenyi
authors.forename: Gunter
authors.initials: G
authors.lastname: Laux
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
mesh_terms: D000368:Aged; D000529:Complementary Therapies / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D005858:Germany; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009985:Orthopedics / Q000706:statistics & numerical data; D015207:Osteoarthritis, Hip / Q000503:physiopathology* / Q000628:therapy; D020370:Osteoarthritis, Knee / Q000503:physiopathology* / Q000628:therapy; D010146:Pain / Q000209:etiology; D010147:Pain Measurement; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011594:Psychometrics / Q000295:instrumentation; D011788:Quality of Life; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires