Prädiktoren der Inanspruchnahme ambulanter medizinischer Leistungen älterer Erwachsener mit einer Arthrose, rheumatoiden Arthritis oder Osteoporose

BACKGROUND: Since chronic musculoskeletal disorders (MD) cause considerable costs for the German health care system, service providers and policy makers need information on the use of the different health care services. On the basis of Andersen's behavioral model, the article provides predictors of ambulatory medical care utilization in the fields of general medicine, orthopaedics and physiotherapy relevant to chronic MD in the 65- to 79-year-old population affected by arthritis, rheumatoid arthritis or osteoporosis in Germany.

METHODS: Based on data of the first wave of the German Health Interview and Examination Survey for Adults (DEGS1) relationships between ambulatory medical care utilization and explanatory variables were analysed using models for count data.

RESULTS: An increased use of general medicine is associated with individual disease factors (considerable health restriction: incidence rate ratio (IRR) 1.64 (1.18-2.27); joint pain: IRR 1.38 (1.06-1.79)). An increased use of orthopaedics is associated with an increased use of general medicine (IRR 1.05 (1.01-1.10)) and an increased use of physiotherapy is determined by structural as well as individual factors (eastern Germany (including Berlin): IRR 0.66 (0.47-0.93); considerable health restriction: IRR 1.84 (1.09-3.12); increased use of orthopaedics: IRR 1.07 (1.01-1.14).

CONCLUSION: As expected, individual disease factors play an important part in explaining the use of health care services. Concurrently, the absence of comorbidity reveals a previously unidentified predictor of a decreased use of general medicine by those with chronic MD.