Consumption of medical resources and outcome of shoulder disorders in primary health care consulters

BACKGROUND Shoulder disorders are common problems in primary health care. The course of disease of patients consulting for a new episode of a shoulder problem has been thought to be benign. In this prospective cohort study, we assessed the one-year consumption of medical resources and clinical outcome of shoulder disorders inclusive of all disease episodes. METHODS All individuals consulting primary health care for shoulder disorder in a catchment area of more than 120 000 people were included. A composite questionnaire including the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) was used to measure use of resources as well as shoulder pain and function. A follow-up assessment was performed after one year. RESULTS A total of 128 individuals responded to the questionnaire. Only 24% of the patients had recovered after one year. Mean shoulder pain (Visual analogue scale, VAS, max 100 mm) decreased from 38.9 mm to 28.6 mm (95% CI -16.3 to -4.2 mm). The ASES score (max 100) improved significantly from 59.9 to 70.2 (95% CI 5.3 to 15.3). Mean one-year consumption of medical resources after the index consultation was 1.5 consultations, 0.5 radiological examinations, and 3.3 visits to physiotherapist. Mean resource-weighted direct costs were €543/patient/year (95% CI €351 to 735). CONCLUSIONS Shoulder disorders are often chronic and require a significant amount of resources from the health care system. The clinical outcome of the management of shoulder disorders in our study population including also individuals who have consulted previously for a shoulder problem is notably poorer than the one reported by previous studies on new episodes. However, despite the relatively modest outcome, subjective disability is low.