The rapid rise in health care costs presents a serious national problem. Care for older patients with osteoarthritis contributes disproportionately to these costs. As the mean age of our population increases it is imperative that we find effective ways to decrease health care utilization. Studies demonstrate an association between naturally-occurring social support and health status, and between experimental education programs and utilization of facilities. Tbe proposed study seeks to find a highly cost-effective combination of social support and education which will decrease utilization, demonstrate that experimentally-produced social support is effective, and possibly increase health status at the same timec If successful, the techniques can be disseminated and generalized to other populations. This study will be conducted in two phases. During Phase I, participating family practitioners and rheumatologists will identify situations in which contacts with the health carc system are unnecessary. During Phase II, 300 patients with osteoarthritis will be randomly assigned to a proven cxperimental condition for producing social support, to an educational program, to a combined condition, or to a control group. All experimental groups will have two-hour weekly meetings for 10 weeks, and then two-hour monthly meetings for ten months. Participants assigned to the social support condition will spend their time developing an enduring support group. The education program participants will receive information, developed during Phase I, about when to use the health care system. The third group will receive a combination of health care utilization education and social support. The fourth group will serve as a no-treatment control. In addition, a group of 75 non-volunteers will be compared to the control group of volunteers. Five """"""""waves"""""""" of sixty patients will be studied. Utilization will be determined via medical records and health status via the Quality of Well-being Scale. Participants will be followed for three years. A number of mediating variables will be studied to determine their effect on the major outcome variables, and a cost-effectiveness model will be developed. If any of the interventions reduce health care utilization by one physician visit per year, as expected, the long-term savings will be great.
Showing the most recent 10 out of 15 publications
