Total care for rheumatic disorders in an integrated health care system

Utilization of care for rheumatic disorders (chapt XIII of ICD) was studied in an area of Sweden during 1978. In the total health care system, approximately 16 to 18% of the population with a rheumatic disorder were seen. The majority (12% of the population) of these patients were treated at the primary care centres. Only 1% were registered as in-patients, 1/4 of whom were admitted to the rheumatology department. Cases with back disorders constituted the largest diagnostic group of rheumatic disorders, both in primary care and in the departments of internal medicine, at the district level as well as in the regional hospital. The most important contribution of the rheumatology department was the care of a select group of patients--those with rheumatoid arthritis and systemic rheumatic diseases. However, primary care saw more patients also within the whole group of inflammatory rheumatic diseases. In the department of orthopaedic surgery, osteoarthritis was the major diagnosis among rheumatic disorders, totalling 38% of their rheumatic in-patients. Selection of patients for specialized care depended upon diagnosis, age, sex and distance to the hospital.