Curtis J. Henke

Correlates of fatigue in older adults with rheumatoid arthritis.

The purposes of this study were to describe the prevalence of fatigue, examine the association between fatigue and doctor visits, and identify correlates of fatigue in rheumatoid arthritis (RA). On average, a high degree of fatigue was reported to occur every day, to remain constant during the course of a week, and to most often affect walking and household chores. When controlling for disease severity and insurance coverage, respondents who reported more fatigue made more visits to the rheumatologist than those reporting less fatigue. A regression model with fatigue as the dependent variable revealed that the following variables explained a significant amount of variance: pain rating, functional status, sleep quality, female gender, comorbid conditions, and duration of disease.

Work loss costs due to peptic ulcer disease and gastroesophageal reflux disease in a health maintenance organization

OBJECTIVE:The aim of this study was to estimate the value of work time and productivity loss because of peptic ulcer disease (PUD) and gastroesophageal reflux disease (GERD).METHODS:A total of 300 adult members of Northern California Kaiser Permanente Medical Care Program with outpatient diagnoses of PUD or GERD were randomly selected for a record review to confirm diagnosis. A telephone survey was conducted soliciting information about work loss because of their disease. Reported work losses were valued at self-reported hourly wage to derive work loss costs. A total of 117 PUD and 102 GERD patients participated.RESULTS:About 75% of each sample was employed full-time or part-time. In all, 42% of potentially working PUD patients and 41% of GERD patients reported some lost work productivity because of their disease. The average loss (per person working) was

A Comparison of the Treatment of Rheumatoid Arthritis in Health Maintenance Organizations and Fee-for-Service Practices

606 for PUD and

Costs of Acid-related Disorders to a Health Maintenance Organization

237 for GERD over a 3-month period. Reduced productivity while at work and part-time work because of the disease were the most costly productivity losses for PUD, whereas time off for physician visits and reduced productivity while at work were the most costly losses for GERD.CONCLUSIONS:Work loss costs for patients with PUD and GERD may be nearly as large as direct medical care costs, and are consistent with the more acute nature of PUD and the chronic pattern of GERD. The work losses resulting from these diseases are large enough to warrant consideration in guideline development and policy decisions for patients with PUD and GERD.

Somatization, psychiatric disorder, and stress in utilization of ambulatory medical services.

This study compares the use of health care services (hospital and ambulatory) by patients with rheumatoid arthritis who were under the care of rheumatologists in prepaid and fee-for-service arrangements. Participating physicians from a random sample of half the rheumatologists in northern California maintained a log of all their patients with well-established diagnoses of rheumatoid arthritis. We interviewed 822 of their patients, using a structured, validated phone survey to obtain information about health care use. Patients in prepaid plans had about the same number and type of hospitalizations and the same rate of surgery as those receiving fee-for-service care. However, fee-for-service patients made more ambulatory visits. We conclude that the use of expensive services (hospital admissions and surgery) for the care of patients with rheumatoid arthritis is not different in fee-for-service and prepaid settings.

Effect of Parenterally Administered Gold Therapy on the Course of Adult Rheumatoid Arthritis

BACKGROUND Little is known about the economic impact of the acid-related disorders (ARDs), which include dyspepsia, gastritis, gastroesophageal reflux disease (GERD), and peptic ulcer disease (PUD), in managed care patient populations. OBJECTIVES To describe the prevalence of medically attended ARDs, and their direct medical costs from the perspective of a large health maintenance organization (HMO). METHODS A total of 1,550 ARDs subjects (age > or = 18 years), were randomly sampled from outpatient diagnosis and pharmacy databases of the Kaiser Permanente Medical Care Program of Northern California and verified by chart review. Five age- and gender-matched controls were identified per subject. One-year prevalence, excess annual costs, and initial 6-month costs for incident cases were estimated using the HMO cost accounting system. RESULTS Total ARDs prevalence (5.8%) increases with advancing age. GERD is the most common ARD (2.9% overall prevalence). Annual per person attributable costs were

Risk Factors for Hospitalization and Surgery in Patients with Rheumatoid Arthritis: Implications for Capitated Medical Payment

1,183,

A cost analysis of a Helicobacter pylori eradication strategy in a large health maintenance organization.

471, and

Study of Internal Medicine

431 respectively for PUD, GERD, and gastritis/dyspepsia. Excess inpatient costs for PUD explain its higher costs. Outpatient costs were somewhat higher for GERD (

The work dynamics of the person with rheumatoid arthritis

279) than for PUD or gastritis/dyspepsia. Pharmacy costs were relatively low for each condition, in part because many patients were treated with generic cimetidine. Total annual HMO expenditures for ARDs were