title: Use of general practice and rheumatology outpatient services in rheumatoid arthritis.
abstract: BACKGROUND
  Patients with rheumatoid arthritis (RA) should be treated in close cooperation between GPs and rheumatologists and following treatment guidelines. In this study, we analyse the utilization of health care among patients with RA and explain the determinants of the frequency of use of GP and rheumatologist services.
  
  
  METHODS
  A random sample (n = 1259) of adult Estonian patients with RA was investigated in 2007. A pre-structured questionnaire included questions regarding respondents' socio-economic status, quality of life, self-reported use of health care, time, distance and financial aspects of access to health care. The impact of the variables on the frequency of use of health care was analysed with regression analysis.
  
  
  RESULTS
  Use of GP services was higher among people who lived outside the capital, had more health problems and experienced disability due to their RA. Time and distance limits had an effect on the frequency of use of both primary and specialist care. A shorter waiting time to the GP and a longer waiting time to the rheumatologist were associated with more frequent use of GP services, but a shorter waiting time to the rheumatologist was related to more frequent visits to the rheumatologist. Patient's costs were not associated with the frequency of health care use.
  
  
  CONCLUSIONS
  Use of health care among people with RA depends primarily upon doctors' waiting times, patients' place of residence and their health status. The GP has a significant role in the management of RA patients, especially for those who have multiple health problems and those living in rural areas.
authors: Department of Internal Medicine, University of Tartu, Tartu, Estonia. kaja.polluste@ut.ee
authors: Kaja
authors: K
authors: Põlluste
authors: Riina
authors: R
authors: Kallikorm
authors: Kersti
authors: K
authors: Meiesaar
authors: Margus
authors: M
authors: Lember
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data*; D001071:Appointments and Schedules; D001172:Arthritis, Rheumatoid / Q000191:economics / Q000628:therapy*; D017281:Cost of Illness; D004957:Estonia; D005260:Female; D058006:General Practice; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data*; D011788:Quality of Life; D012219:Rheumatology; D057566:Self Report; D012959:Socioeconomic Factors; D055815:Young Adult