Lupus Patients Decrease Clinical Health Care Use Over Time

Researchers investigated health care use by people with systemic lupus erythematosus (SLE) and found that patients were more apt to seek clinical care during the first few years after diagnosis, but became less inclined over time. SLE patients also tend to turn increasingly more to general physician care, over encounters with specialists such as rheumatologists.

The research paper, “Utilization of Ambulatory Physician Encounters, Emergency Room Visits, and Hospitalizations by Systemic Lupus Erythematosus Patients: A 13-Year Population Health Study,” was published in the journal  Arthritis Care & Research.

Researchers gathered information on total physician encounters, emergency room (ER) visits, and hospitalizations of SLE patients and control subjects, over a period of 13 years. Information was gleaned from the Nova Scotia Medical Services Insurance database. Seven SLE case definitions were used and each case was matched by age and sex to four randomly selected controls that had no previous history of connective tissue disease.

The number of evaluated SLE cases varied from  564 to 4,494 depending on the case definition used by researchers. The average patient age varied from 47.7 to 50.6 years; the female proportion varied from 78.0% to 85.1%.

Compared to the controls, SLE patients had a significantly higher health care utilization, but SLE utilization of physicians declined significantly after the first year following diagnosis —  for all case definitions. By the fourth year of evaluation, visits to subspecialized doctors decreased by 60% (rheumatologists), 50% (internists), and 31% (other physicians).

On the other hand, visits to family doctors decreased only by 9%, remaining high for SLE patients during the study period. Emergency room visits were also higher and more frequent among SLE patients, in all case definitions, during the first years following diagnosis but also declined over time. The same pattern was found for hospital admissions, in two of the seven case definitions.

The researchers concluded that rheumatologists’ involvement was maximal during the first years following diagnosis and, over time, family physician visits are preferred over subspecialized involvement, predominating over other physicians’ groups.

“The findings were remarkably consistent,” the researchers wrote in the study, according to a news release. “Regardless of the SLE case definition, physician encounters were highest in the year of diagnosis, trending lower in subsequent years but always remaining above those in matched controls.”