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.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
First Independent Research Support & Transition (FIRST) Awards (R29)
Project #
5R29AR040423-02
Application #
3457417
Study Section
Behavioral Medicine Study Section (BEM)
Project Start
1991-07-01
Project End
1996-06-30
Budget Start
1992-07-01
Budget End
1993-06-30
Support Year
2
Fiscal Year
1992
Total Cost
Indirect Cost
Name
San Diego State University
Department
Type
Schools of Arts and Sciences
DUNS #
073371346
City
San Diego
State
CA
Country
United States
Zip Code
92182
Bigatti, Silvia M; Hernandez, Ann Marie; Cronan, Terry A et al. (2008) Sleep disturbances in fibromyalgia syndrome: relationship to pain and depression. Arthritis Rheum 59:961-7
Groessl, Erik J; Kaplan, Robert M; Cronan, Terry A (2003) Quality of well-being in older people with osteoarthritis. Arthritis Rheum 49:23-8
Cronan, Terry A; Walen, Heather R (2002) Accuracy of self-reported healthcare use in patients with osteoarthritis. J Rheumatol 29:2181-4
Groessl, E J; Cronan, T A (2000) A cost analysis of self-management programs for people with chronic illness. Am J Community Psychol 28:455-80
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Cronan, T A; Durkin, K A; Groessl, E et al. (1997) Health care costs for volunteers and non-volunteers in an intervention for people with osteoarthritis. Arthritis Care Res 10:36-42
Gallagher, R A; Miller, C; Cronan, T A et al. (1997) Gender differences in participation and responsiveness to a health intervention for older Americans. Women Health 25:63-81
Kochevar, R J; Kaplan, R M; Weisman, M (1997) Financial and career losses due to rheumatoid arthritis: a pilot study. J Rheumatol 24:1527-30

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