title: Diagnosis and referral of rheumatoid arthritis by primary care physician: results of a pilot study on the city of Pisa, Italy.
abstract: The aims of the present study were to evaluate, in the city of Pisa: (1) the prevalence of rheumatoid arthritis; (2) the reliability of the prevalence estimated by primary care physicians, using the rheumatologist's diagnosis as the "gold standard" and (3) the economic impact of the disease. The Tuscany registry of primary care physicians constituted the framework from which a sample of subjects was selected. The rheumatoid arthritis (RA) subjects >18 years followed by each primary care physician constituted the population studied. Each general practitioner (GP) was asked to fill out a questionnaire regarding their patients affected by RA and to send it to the tertiary rheumatologic centre, where the diagnosis was confirmed/discarded, the clinical and epidemiological data were collected in a standardized form and a number of data for the estimation of costs were gathered. The estimated prevalence of RA was 5.1 per thousand (CI, 4.4-5.7). The reliability of general practitioners in the diagnosis of rheumatoid arthritis was on the whole 69%. However, when an analysis of every physician was carried out, a high degree of heterogeneity in the prevalence of RA per physician was found. Overall, the mean annual cost per patient with RA was estimated at about 5,878 euro (euro; median, 6,434 euro; inter quartile range, 669-7,052 euro), with a high variability mainly dependent on the degree of patient disability. More than 90% of the overall annual cost per patient was due to the medical and non-medical direct components of costs. The prevalence of RA in Tuscany seems highly comparable with similar prevalence studies in Italy. The annual cost per patient with RA was highly variable and strictly dependent on the level of disability. More than 90% of the overall cost was due to the direct burden of costs.
authors.affiliation: Department of Internal Medicine, Rheumatology Unit, S. Chiara Hospital, University of Pisa, Via Roma 67, 56126, Pisa, Italy. a.dellarossa@int.med.unipi.it
authors.forename: Alessandra
authors.initials: A
authors.lastname: Della Rossa
authors.forename: Rossella
authors.initials: R
authors.lastname: Neri
authors.forename: Rosaria
authors.initials: R
authors.lastname: Talarico
authors.forename: Marica
authors.initials: M
authors.lastname: Doveri
authors.forename: Arianna
authors.initials: A
authors.lastname: Consensi
authors.forename: Stefano
authors.initials: S
authors.lastname: Salvadori
authors.forename: Valentina
authors.initials: V
authors.lastname: Lorenzoni
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Turchetti
authors.forename: Stefania
authors.initials: S
authors.lastname: Bellelli
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Cazzato
authors.forename: Laura
authors.initials: L
authors.lastname: Bazzichi
authors.forename: Paolo
authors.initials: P
authors.lastname: Monicelli
authors.forename: Stefano
authors.initials: S
authors.lastname: Moscardini
authors.forename: Stefano
authors.initials: S
authors.lastname: Bombardieri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000191:economics / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family / Q000706:statistics & numerical data*; D010865:Pilot Projects; D015995:Prevalence; D011788:Quality of Life; D012017:Referral and Consultation / Q000191:economics / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
chemical_list: D018501:Antirheumatic Agents