Regional rheumatology practice in Umeå a northern Swedish experience

In 1973 rheumatology was reorganized in northern Sweden and a new center was developed to serve a county of 240,000 inhabitants. The results of this development from 1973 to 1977 are reported. Although the number of rheumatic disease beds available was slightly reduced an increased staff was able to reduce the average duration of hospital stay from 42 to 15 d. This was true for all diagnostic groups, both for conventional hospital wards and a comprehensive day-ward center. Initially, rheumatoid arthritis (RA) had the highest priority and the number of patients with this diagnosis increased. However, after 3 yr RA was diagnosed in only 12% of new out-patients and other rheumatic disorders became more frequent among both out- and in-patients. New patients were referred almost equally from primary care and other hospital departments. Although only 20% of patients came with a provisional diagnosis, half of these were changed after examination by the rheumatology department. An increased demand for diagnostic services and a rapidly changing diagnostic pattern are 2 important factors to be considered in the planning of any new rheumatology center.