title: Consumption of medical resources and outcome of shoulder disorders in primary health care consulters.
abstract: BACKGROUND
  Shoulder disorders are common problems in primary health care. The course of disease of patients consulting for a new episode of a shoulder problem has been thought to be benign. In this prospective cohort study, we assessed the one-year consumption of medical resources and clinical outcome of shoulder disorders inclusive of all disease episodes.
  
  
  METHODS
  All individuals consulting primary health care for shoulder disorder in a catchment area of more than 120 000 people were included. A composite questionnaire including the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) was used to measure use of resources as well as shoulder pain and function. A follow-up assessment was performed after one year.
  
  
  RESULTS
  A total of 128 individuals responded to the questionnaire. Only 24% of the patients had recovered after one year. Mean shoulder pain (Visual analogue scale, VAS, max 100 mm) decreased from 38.9 mm to 28.6 mm (95% CI -16.3 to -4.2 mm). The ASES score (max 100) improved significantly from 59.9 to 70.2 (95% CI 5.3 to 15.3). Mean one-year consumption of medical resources after the index consultation was 1.5 consultations, 0.5 radiological examinations, and 3.3 visits to physiotherapist. Mean resource-weighted direct costs were €543/patient/year (95% CI €351 to 735).
  
  
  CONCLUSIONS
  Shoulder disorders are often chronic and require a significant amount of resources from the health care system. The clinical outcome of the management of shoulder disorders in our study population including also individuals who have consulted previously for a shoulder problem is notably poorer than the one reported by previous studies on new episodes. However, despite the relatively modest outcome, subjective disability is low.
authors: Department of Surgery, Unit of Family Practice, Central Finland Central Hospital, Keskussairaalantie 19, Jyväskylä 40620, Finland. juha.paloneva@ksshp.fi.
authors: Juha
authors: J
authors: Paloneva
authors: Sanna
authors: S
authors: Koskela
authors: Hannu
authors: H
authors: Kautiainen
authors: Mauno
authors: M
authors: Vanhala
authors: Ilkka
authors: I
authors: Kiviranta
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D020069:Shoulder Pain / Q000191:economics*; D016896:Treatment Outcome