POS1516 HEALTHCARE UTILIZATION IN GENERAL PRACTICE AND HOSPITALS PRECEDING A DIAGNOSIS OF SYSTEMIC SCLEROSIS: A NATIONWIDE DANISH REGISTRY STUDY.
Authors: Fie Juul Praastrup, Annette De Thurah, Linda A Rasmussen, Esben Naeser, Ellen-Margrethe Hauge
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Early diagnosis and treatment initiation is essential in systemic sclerosis (SSc) to prevent irreversible tissue damage of the skin and internal organs. Still, many patients with SSc experience a significant diagnostic delay from symptom presentation to the diagnosis of SSc. Both patient factors, healthcare factors, and disease factors(1) contribute to this delay, hindering early identification and interventions. Increased utilization of healthcare before an SSc diagnosis can be seen as a proxy for symptom presentation and the action taken by healthcare professionals, and thus indicate an opportunity for earlier diagnosis. However, there is a lack of information about help-seeking behavior prior to a diagnosis of SSc. <h3>Objectives:</h3> To investigate healthcare utilization three years preceding a diagnosis of SSc in Denmark. <h3>Methods:</h3> We conducted a population-based cohort study using data from Danish national registries. Incident patients with SSc diagnosed between 2005–2018 were matched with 10 references without SSc from the Danish background population. The date of diagnosis was considered the index date. Healthcare utilization was defined as number of (i) contacts to general practice, (ii) contacts to hospitals, and (iii) radiological examinations conducted in secondary care. Quarterly contact rates for patients with SSc and references in the three years preceding the diagnosis were calculated. We compared their health care utilization by estimating an incidence rate ratio (IRR) for each 3-month period, adjusted for sociodemographic characteristics and comorbidities. <h3>Results:</h3> 1,650 patients with SSc were included and matched with 16,500 references based on age and gender. The median age was 58 years (interquartile range (IQR): 48–68), and 76.1% were women. Patients with SSc had significantly more contact with general practices, hospitals and underwent more radiological examinations through the three years prior to diagnosis. Women had an average of 2.8–3.0 contacts per quarter in general practice from three years until two years preceding the index date. This increased to an average of 4.7 from two years preceding the diagnosis until the last quarter (Figure 1). Female references had a stable contact rate throughout the entire study period ranging between 1.9-2.1 contacts per quarter. Men displayed a similar pattern, although the increase in contact rates occurred in closer proximity to the index date. Increasing contact rates with hospitals from two years prior to the date of diagnosis was seen, while a steep rise in the number of radiological examinations was seen in the last quarter prior to diagnosis. <h3>Conclusion:</h3> Patients with SSc had significantly more contacts with general practices and hospitals and more frequently underwent radiological examinations through the three years prior to diagnosis compared to their references. This knowledge may offer a window of opportunity to accelerate the referral process for specialized care and facilitate an earlier diagnosis of SSc. <h3>REFERENCES:</h3> [1] Walter F, Webster A, Scott S, Emery J. The Andersen Model of Total Patient Delay: a systematic review of its application in cancer diagnosis. J Health Serv Res Policy. 2012;17(2):110-8. <h3>Acknowledgements:</h3> The authors thank data manager Kaare Rud Flarup for his great work in the retrieval of data from the national registries. <h3>Disclosure of Interests:</h3> <b>None declared</b>