Dept. for Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway.
Dept. of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway.
BMC Health Serv Res. 2023 Aug 14;23(1):858. doi: 10.1186/s12913-023-09852-3.
Patients with musculoskeletal disorders (MSDs) access health care in different ways. Despite the high prevalence and significant costs, we know little about the different ways patients use health care. We aim to fill this gap by identifying which combinations of health care services patients use for new MSDs, and its relation to clinical characteristics, demographic and socioeconomic factors, long-term use and costs, and discuss what the implications of this variation are.
The study combines Norwegian registers on health care use, diagnoses, comorbidities, demographic and socioeconomic factors. Patients (≥ 18 years) are included by their first health consultation for MSD in 2013-2015. Latent class analysis (LCA) with count data of first year consultations for General Practitioners (GPs), hospital consultants, physiotherapists and chiropractors are used to identify combinations of health care use. Long-term high-cost patients are defined as total cost year 1-5 above 95 percentile (≥ 3 744€).
We identified seven latent classes: 1: GP, low use; 2: GP, high use; 3: GP and hospital; 4: GP and physiotherapy, low use; 5: GP, hospital and physiotherapy, high use; 6: Chiropractor, low use; 7: GP and chiropractor, high use. Median first year health care contacts varied between classes from 1-30 and costs from 20€-838€. Eighty-seven percent belonged to class 1, 4 or 6, characterised by few consultations and treatment in primary care. Classes with high first year use were characterised by higher age, lower education and more comorbidities and were overrepresented among the long-term high-cost users.
There was a large variation in first year health care service use, and we identified seven latent classes based on frequency of consultations. A small proportion of patients accounted for a high proportion of total resource use. This can indicate the potential for more efficient resource use. However, the effect of demographic and socioeconomic variables for determining combinations of service use can be interpreted as the health care system transforming unobserved patient needs into variations in use. These findings contribute to the understanding of clinical pathways and can help in the planning of future care, reduction in disparities and improvement in health outcomes for patients with MSDs.
患有肌肉骨骼疾病（MSD）的患者以不同的方式获得医疗保健。尽管患病率高且成本高昂，但我们对患者使用医疗保健的不同方式知之甚少。我们旨在通过确定患者新患 MSD 时使用的医疗保健服务组合，并探讨其与临床特征、人口统计学和社会经济因素、长期使用和成本的关系来填补这一空白，并讨论这种变化的影响。
该研究结合了挪威的医疗保健使用、诊断、合并症、人口统计学和社会经济因素登记册。通过 2013-2015 年首次 MSD 健康咨询纳入患者（≥18 岁）。使用计数数据的潜在类别分析（LCA）对全科医生（GP）、医院顾问、物理治疗师和脊椎按摩师的第一年就诊情况进行分析，以确定医疗保健使用的组合。长期高成本患者定义为 1-5 年总成本超过第 95 百分位数（≥3744 欧元）。
我们确定了七个潜在类别：1：GP，低使用率；2：GP，高使用率；3：GP 和医院；4：GP 和物理治疗，低使用率；5：GP、医院和物理治疗，高使用率；6：脊椎按摩师，低使用率；7：GP 和脊椎按摩师，高使用率。第一年的医疗保健接触中位数在类别 1、4 或 6 之间从 1-30 不等，费用从 20 欧元到 838 欧元不等。87%的患者属于第 1、4 或 6 类，其特点是初级保健中的就诊次数和治疗次数较少。第一年高使用率的类别以较高的年龄、较低的教育程度和更多的合并症为特征，并且在长期高成本患者中占比较高。
第一年医疗保健服务使用存在较大差异，我们根据就诊频率确定了七个潜在类别。一小部分患者的总资源使用占比很高。这可能表明资源使用效率更高。然而，人口统计学和社会经济变量对服务使用组合的确定可以解释为医疗保健系统将未观察到的患者需求转化为使用中的差异。这些发现有助于了解临床途径，并有助于规划未来的护理、减少差异和改善 MSD 患者的健康结果。
