The full content of Annals is available to subscribers

Subscribe/Learn More  >
Reviews |

Costs, Outcomes, and Patient Satisfaction by Provider Type for Patients with Rheumatic and Musculoskeletal Conditions: A Critical Review of the Literature and Proposed Methodologic Standards

Daniel H. Solomon, MD; David W. Bates, MD, MS; Richard S. Panush, MD; and Jeffrey N. Katz, MD, MS
[+] Article, Author, and Disclosure Information

From Robert B. Brigham Multipurpose Arthritis and Musculoskeletal Diseases Center, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts; and Saint Barnabas Medical Center, University of Medicine and Dentistry of New Jersey, and New Jersey Medical School, Livingston, New Jersey. Acknowledgments: The authors thank Drs. John Z. Ayanian and Neil A. Solomon for their insightful comments on earlier drafts of this manuscript and Matthew Liang, MD, MPH, for valuable feedback and encouragement. Grant Support: In part by a grant from the American Academy of Orthopedic Surgeons, grant AR36308 from the National Institutes of Health, a Physician Scientist Development Award (Dr. Solomon), and an Arthritis Foundation Clinical Science Award (Dr. Katz). Requests for Reprints: Jeffrey N. Katz, MD, MS, Robert B. Brigham Multipurpose Arthritis and Musculoskeletal Diseases Center, Division of Rheumatology and Immunology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. Current Author Addresses: Drs. Solomon and Katz: Robert B. Brigham Multipurpose Arthritis and Musculoskeletal Diseases Center, Division of Rheumatology and Immunology, Brigham and Women's Hospital, 75 Francis Street, Boston MA 02115. Dr. Bates: Division of General Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. Dr. Panush: Department of Medicine, Saint Barnabas Medical Center, Old Short Hills Road, Livingston, NJ 07039.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1997;127(1):52-60. doi:10.7326/0003-4819-127-1-199707010-00009
Text Size: A A A

Purpose: To compare the outcomes of care provided by generalists with that provided by specialists for patients with musculoskeletal and rheumatic conditions.

Data Sources: English-language studies published between 1966 and April 1996 were identified through a MEDLINE search.

Study Selection: Studies that compared generalists' and specialists' treatment preferences, appropriateness of care, or outcomes with regard to musculoskeletal and rheumatic conditions were examined.

Data Extraction: Studies were reviewed for methodologic rigor and outcomes.

Data Synthesis: Low back pain is treated by many types of providers, without consistent differences in outcomes across provider types. In one study, however, patients were more satisfied with chiropractic care than with care provided by primary care physicians, although the former cost twice as much as the latter. For osteoarthritis of the hip, rheumatologists and primary care providers reported using different therapeutic regimens. For acute mono- and oligoarthritis, rheumatologists performed arthrocentesis more appropriately than nonrheumatologists and produced shorter durations of hospitalization. In the management of gout, rheumatologists used colchicine during the introduction of urate-lowering therapy more appropriately than other providers. In two population-based cohorts of patients with rheumatoid arthritis, patients cared for by rheumatologists were prescribed significantly more disease-modifying agents and had less disability than patients cared for by generalists.

Conclusions: Although empirical data are scant, there seem to be differences between generalists and specialists for a range of outcomes in various musculoskeletal and rheumatic conditions. Studies to date have important methodologic limitations that need to be addressed in future research.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.