Combination of Health Care Service Use and the Relation to Demographic and Socioeconomic Factors for Patients With Musculoskeletal Disorders: A Descriptive Cohort Study

Abstract

Abstract BACKGROUND Patients with musculoskeletal disorders (MSDs) access health care in different ways. Despite the high prevalence the significant costs associated with the disorders, we know little about the different ways patients use health care. We aim to fill this gap by identifying what combinations of health care services patients use for new MSD in Norway, and discuss possible implications of this variation.METHODS The study combines Norwegian registers on health care use, diagnosis, comorbidities, demographic and socioeconomic factors. Patients (≥ 18 years) are included by their first health consultation for MSD in 2013–2015. Latent class analysis (LCA) with count data of first year consultations for GP, hospital, physiotherapy and chiropractor are used to identify combinations of health care use. Long-term high-cost patients are defined as total reimbursement costs year 1–5 above 95th percentile (≥ 3 744€).RESULTS We identified seven classes: 1: GP, low use; 2: GP, high use; 3: GP and hospital; 4: GP and physiotherapy, low use; 5: GP, hospital and physiotherapy, high use; 6: Chiropractor, low use; 7: GP and chiropractor, high use. Median first year health care contacts varied between classes from 1 to 30 and costs from 20€ to 838€. Eighty-seven percent belonged to class 1, 4 or 6 with low use of health care resources. Classes with high use were characterised by higher age, lower education and more comorbidity and were overrepresented among the long-term high-cost users.CONCLUSION There were a large variation in first year health care service use, and we identified seven latent classes based on frequency of use of different health care services. A low proportion of patients accounts for a high proportion of total resource use. The classes showed considerable differences in demographic and socioeconomic factors, highlighting the significance of these factors for how patients use health care services for their MSDs. These findings contributes to the understanding of clinical pathways for patients with MSD and can help in planning of future care. More research is required to determine whether the observed variations are due to lack of equity in health care delivery or differences in patient-needs.