A Longitudinal Study of Ambulatory Physician Encounters, Emergency Room Visits, and Hospitalizations by Patients with Rheumatoid Arthritis: A 13-year Population Health Study

Objective. To determine total physician encounters, emergency room (ER) visits, and hospitalizations in an incident cohort of rheumatoid arthritis (RA) cases and matched control patients over 13 years. Methods. A retrospective cohort study was performed using administrative healthcare data from about 1 million people with access to universal healthcare. Using the International Classification of Diseases, 9th ed (ICD-9) and ICD-10 diagnostic codes, 7 RA case definitions were used. Each case was matched by age and sex to 4 randomly selected controls. Data included physician billings, ER visits, and hospital discharges over 13 years. Results. The number of incident RA cases varied from 3497 to 27,694, depending on the case definition. The mean age varied from 54.3 to 65.0 years, and the proportion of women from 67.8% to 71.3%. The number of physician encounters by patients with RA was significantly higher than by controls. It was highest in the index year and declined promptly thereafter for all case definitions and by 12.2%-46.8% after 10 years. Encounters with subspecialty physicians fell by 61% (rheumatologists) and 34% (internal medicine). In contrast, clinical encounters with family physicians and other physicians fell by only 9%. Visits to the ER and hospital admissions were also significantly higher in RA cases, particularly early in the disease, and fell significantly over the followup. Conclusion. In patients with RA, healthcare use is highest in the first year following the diagnosis, which is also the time of maximal involvement by rheumatologists. Use declines over time, and encounters with patients' family physicians predominate over other physician groups.