Department of Public Health Sciences, Clemson University, Clemson, SC, USA.
Center for Effectiveness Research in Orthopaedics, Greenville, USA.
BMC Geriatr. 2022 Jun 30;22(1):548. doi: 10.1186/s12877-022-03230-0.
Primary adhesive capsulitis (AC) is not well understood, and controversy remains about the most effective treatment approaches. Even less is known about the treatment of AC in the Medicare population. We aimed to fully characterize initial treatment for AC in terms of initial treatment utilization, timing of initial treatments and treatment combinations.
Using United States Medicare claims from 2010-2012, we explored treatment utilization and patient characteristics associated with initial treatment for primary AC among 7,181 Medicare beneficiaries. Patients with primary AC were identified as patients seeking care for a new shoulder complaint in 2011, with the first visit related to shoulder referred to as the index date, an x-ray or MRI of the shoulder region, and two separate diagnoses of AC (ICD-9-CM codes: 726.00). The treatment period was defined as the 90 days immediately following the index shoulder visit. A multivariable logistic model was used to assess baseline patient factors associated with receiving surgery within the treatment period.
Ninety percent of beneficiaries with primary AC received treatment within 90 days of their index shoulder visit. Physical therapy (PT) alone (41%) and injection combined with PT (34%) were the most common treatment approaches. Similar patient profiles emerged across treatment groups, with higher proportions of racial minorities, socioeconomically disadvantaged and more frail patients favoring injections or watchful waiting. Black beneficiaries (OR = 0.37, [0.16, 0.86]) and those residing in the northeast (OR = 0.36, [0.18, 0.69]) had significantly lower odds of receiving surgery in the treatment period. Conversely, younger beneficiaries aged 66-69 years (OR = 6.75, [2.12, 21.52]) and 70-75 years (OR = 5.37, [1.67, 17.17]) and beneficiaries with type 2 diabetes had significantly higher odds of receiving surgery (OR = 1.41, [1.03, 1.92]).
Factors such as patient baseline health and socioeconomic characteristics appear to be important for physicians and Medicare beneficiaries making treatment decisions for primary AC.
原发性粘连性肩关节囊炎（AC）的发病机制尚不清楚，对于最有效的治疗方法仍存在争议。对于医疗保险人群中 AC 的治疗，人们知之甚少。我们旨在从初始治疗的利用、初始治疗的时机和治疗组合方面全面描述原发性 AC 的初始治疗。
使用美国 2010-2012 年医疗保险索赔数据，我们在 7181 名医疗保险受益人群中探讨了原发性 AC 初始治疗的利用情况以及与初始治疗相关的患者特征。原发性 AC 患者被定义为在 2011 年因新肩部不适就诊的患者，首次就诊与肩部相关的就诊日期为索引日期，肩部区域进行 X 光或 MRI，并且有两个单独的 AC 诊断（ICD-9-CM 代码：726.00）。治疗期定义为索引肩部就诊后 90 天内。使用多变量逻辑模型评估与治疗期内接受手术相关的基线患者因素。
90%的原发性 AC 患者在索引肩部就诊后 90 天内接受了治疗。单独的物理治疗（PT）（41%）和注射联合 PT（34%）是最常见的治疗方法。在各个治疗组中，患者的特征相似，种族少数群体、社会经济地位较低和身体虚弱的患者更倾向于注射或观察等待。黑人受益人的手术可能性显著降低（OR=0.37，[0.16，0.86]），东北部的受益人的手术可能性也显著降低（OR=0.36，[0.18，0.69]）。相反，66-69 岁（OR=6.75，[2.12，21.52]）和 70-75 岁（OR=5.37，[1.67，17.17]）的年轻受益人和患有 2 型糖尿病的受益人的手术可能性显著升高（OR=1.41，[1.03，1.92]）。
患者的基线健康和社会经济特征等因素似乎对原发性 AC 的治疗决策具有重要意义，医生和医疗保险受益人均应考虑这些因素。
