title: Utilization of health services and prescription patterns among lupus patients followed by primary care physicians and rheumatologists in Puerto Rico.
abstract: OBJECTIVE
  To examine the utilization of health services and prescription patterns among patients with systemic lupus erythematosus (SLE) followed by primary care physicians and rheumatologists in Puerto Rico.
  
  
  METHODS
  The insurance claims submitted by physicians to a health insurance company of Puerto Rico in 2003 were examined. The diagnosis of lupus was determined by using the International Classification of Diseases, Ninth Revision, code for SLE (710.0). Of 552,733 insured people, 665 SLE patients were seen by rheumatologists, and 92 were followed by primary care physicians. Demographic features, selected co-morbidities, healthcare utilization parameters, and prescription patterns were examined. Fisher exact test, chi2 test, and analysis of variances were used to evaluate differences between the study groups.
  
  
  RESULTS
  SLE patients followed by rheumatologists had osteopenia/osteoporosis diagnosed more frequently than did patients followed by primary care physicians. The frequency of high blood pressure, diabetes mellitus, hypercholesterolemia, coronary artery disease, and renal disease was similar for both groups. Rheumatologists were more likely to order erythrocyte sedimentation rate, anti-dsDNA antibodies, and serum complements. No differences were observed for office or emergency room visits, hospitalizations, and utilization of routine laboratory tests. Rheumatologists prescribed hydroxychloroquine more frequently than did primary care physicians. The use of nonsteroidal anti-inflammatory drugs, cyclooxygenase-2 inhibitors, glucocorticoids, azathioprine, cyclophosphamide, and methotrexate was similar for both groups.
  
  
  CONCLUSIONS
  Overall, the utilization of health services and prescription patterns among SLE patients followed by primary care physicians and rheumatologists in Puerto Rico are similar. However, rheumatologists ordered SLE biomarkers of disease activity and prescribed hydroxychloroquine more frequently than did primary care physicians.
authors.affiliation: Department of Medicine, Division of Rheumatology, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico, USA.
authors.forename: María J
authors.initials: MJ
authors.lastname: Molina
authors.forename: Angel M
authors.initials: AM
authors.lastname: Mayor
authors.forename: Alejandro E
authors.initials: AE
authors.lastname: Franco
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Morell
authors.forename: Miguel A
authors.initials: MA
authors.lastname: López
authors.forename: Luis M
authors.initials: LM
authors.lastname: Vilá
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003710:Demography; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011320:Primary Health Care; D011647:Puerto Rico / Q000453:epidemiology; D012219:Rheumatology