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Outcomes/Effectiveness Research

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Both specialists and internists improve outcomes for knee and shoulder pain, but they go about it differently

Knee pain and shoulder pain are second only to low back pain as musculoskeletal disorders that plague adults in the United States each year. Patients with knee and shoulder pain are managed by many types of doctors, ranging from family doctors and chiropractors to rheumatologists and orthopedic surgeons. Determining which type of provider gives better care for these problems depends on which outcomes are measured, according to a recent study.

General internists, rheumatologists, and orthopedic surgeons provide about the same improvement in functioning and symptom relief. However, when it comes to patient satisfaction and cost, there are trade-offs between generalist and specialist care, conclude the authors of the study. The research was supported in part by the Agency for Healthcare Research and Quality (HS09775).

Jeffrey N. Katz, M.D., of Harvard Medical School, and his colleagues evaluated the outcomes of care provided to over 400 adult patients diagnosed with noninflammatory knee or shoulder disorders by general internists, rheumatologists, and orthopedic surgeons in 1996 and 1997. They analyzed patient responses to a baseline survey and a second survey 3 months later about pain severity, functional status, medical resource use, and satisfaction with care. After adjusting for individual patient factors at baseline, there were no significant differences among provider groups in pain relief or functional improvement during followup.

Those treated by rheumatologists were more satisfied with the doctor-patient interaction than those treated by general internists, and patients of orthopedic surgeons were most satisfied with treatment results. Patients reported that rheumatologists and orthopedic surgeons were more likely to answer their questions than internists. However, the specialists were more costly. Orthopedic surgeons obtained significantly more x-rays of the knee or shoulder and more magnetic resonance imaging scans of the knee. Rheumatologists performed significantly more aspirations or injection procedures.

These findings confirm that there is greater patient satisfaction, but higher costs, associated with specialist care for shoulder and knee pain.

See "Outcomes of care and resource utilization among patients with knee or shoulder disorders treated by general internists, rheumatologists, or orthopedic surgeons," by Dr. Katz, Daniel H. Solomon, M.D., M.P.H., Jonathan L. Schaffer, M.D., and others, in the January 2000 American Journal of Medicine 108, pp. 28-35.

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