Need/demand factors used in rheumatology workforce studies
| Author, year | Scope of diseases covered by rheumatology specialty8 | Disease definition9 | Source of prevalence data* | Visits/year per patient10 | % patients referred to rheumatologist11 | Projection of population development12 | Source used for projection of population development* | Projection of epidemiology of diseases13 | Source used for projection of epidemiology of diseases* | Effects of medical development14 | National economic indicators15 |
| Ogryzlo, 197526 | Not stated
| Not stated
| Author’s estimate16 | Not stated
| Not stated
| Not stated
| Not stated | Not stated
| Not stated | Not stated
| Not stated
|
| Marder et al, 199114 | 20 conditions and fibromyalgia and osteoporosis Modified Graduate Medical Education National Advisory Committee (GMENAC) list17 | ICD9-CM
| National Arthritis Data work group (NADW) | 2–4 visits/year per patient18 | Estimated for each disease separately
| Age
| United States Bureau of the Census population (US Census projections) | Not stated
| Not stated | Regular referral patterns and average number of visits may change due to medical developments, but too little info was available to estimate
| Not stated
|
| Deal et al, 200715 | 8 diseases19 | Partially cited20 | NADW 5 and updates | Not stated
| Estimated for each disease separately21 | Age
| US Census projections | Not stated
| Not stated | Discusses effect of medical development and change in practice organisation, difficult to quantify
| Per capita income and insurance status
|
| Zummer and Henderson, 200018 | Not stated
| Not stated
| Author’s estimate22 | Not stated
| Not stated
| Age
| Not stated | Not stated
| Not stated | Not stated
| Not stated
|
| Edworthy, 200019 | 7 disease(s) groups23 | Not stated
| Author’s estimate24 | Time consumed by patient/year with range 0.7–3 hours
| Estimated for some disease groups
| Not stated
| Not stated | Not stated
| Not stated | Not stated
| Not stated
|
| Hanly, 200120 | Not stated
| Not stated
| Not stated | Not stated
| Not stated
| Age
| Statistics Canada | Not stated
| Not stated | Not stated
| Not stated
|
| Raspe, 199522 | 6 disease groups25 | Partially cited6
| Author’s estimate[26 | Four visits/year per patient
| Not stated
| Not stated
| Not stated | Not stated
| Not stated | Not stated
| Not stated
|
| German Society for Rheumatology, Committee for Care, 200821 | 5 inflammatory disease groups27 and 5 other disease groups28 | Not stated
| Author’s estimate29 | Number of visits differ from type of disease: average of 4 visits/year per patient30 | Estimated 100% inflammatory, 12% of other diseases
| Not stated
| Not stated | Assumed not to change
| Not stated | Not stated
| Not stated
|
| Làzaro y De Mercado, 201325 | 12 disease groups31 | Not stated
| Not stated | Not stated
| Not stated
| Age
| National Institute of Statistics | Not stated
| Not stated | Improvement of medical technologies increases manpower need
| Not stated
|
| Committee of Rheumatology, 198823 | 5 disease groups32 | Not stated
| Author’s estimate33 | Not stated
| Inflammatory 100%, 12% of other diseases
| Not stated
| Not stated | Assumed not to change
| Not stated | Not stated
| Not stated
|
| Rowe et al, 201324 | 12 disease(s) groups34 | Partially cited6
| Several UK and international studies | As per NICE guidelines, distinguishes between first visit (30 min) and follow-up visit (10–15 min)
| Considered but no details provided
| Not stated
| Not stated | Not stated
| Not stated | Discusses workload increase due to more frequent use of toxic drugs
| Not stated
|
| American College of Rheumatology, 201538 | 10 diseases35 | Self-reported: physician-diagnosed and self-diagnosed
| National Health Information Systems Surveillance statistics, Centers for Disease Control and Prevention36 | Not stated
| Assessed number of visits in the patient population (proxy to % of patients referred), specific assumptions for OA are given37 | Age and sex
| US Census projections | Discussed increased numbers due to obesity trends
| Data (of RA) based on the Rochester Epidemiology Project in Minnesota and different studies | Discussed changes in cost of drugs
| Household annual income and socioeconomic conditions
|
| HRSA Health Workforce, 201516 | Diseases of the musculoskeletal system and connective tissue38 | ICD9 (codes 725–729)
| U.S. Centers for Medicare and Medicaid Services | Not stated
| Not stated
| Age and sex
| ACS, BRFSS, NNHS, Census Bureau | Health status for prediction of the use of healthcare
| Not stated | Assumed healthcare delivery will not change substantially from the base year
| Household anual income and socioeconomic status
|
| German Society for Rheumatology, 20177 | Inflammatory diseases39 and autoinflammatory diseases
| Not stated
| Based on Zink et al, 20167 | Estimated amount and time for prevalent (4×20 min) and incident cases (1.5×40 min)
| Assumptions for co-consultation for osteoarthritis, osteoporosis and pain syndromes are given41 | Age
| Not stated | Not stated
| Not stated | Discusses that digital developments and other health personnel may have an influence on workload
| Amount of insurance services is discussed
|
The risk of bias scores: red dot (
)=high risk of bias, indicating that the factor has not been considered or considered in an inadequate way, in workforce prediction model; orange dot ()=moderate risk of bias, when a factor has been considered with limitations; green dot ()=low risk of bias and corresponds to a well-considered factor in sufficient level of detail and based on a reliable evidence. Detailed description of grading system is presented in online supplementary table S7.(1) The scope of diseases covered by rheumatology specialty is defined and the probability that it is representative is high.
(2) A criteria-stated disease definition that relies on physician-reported diagnoses and using more than one source is recommended.
(3) Separate estimations for the type of diseases, the disease phase or the type of visits should be done.
(4) It is recommended to consider separate estimations of the percentage of referrals per disease group.
(5) For the consideration of the development of the population, workforce calculations should incorporate age and/or sex structure and/or other factors, relying on more than one data source.
(6) The involvement of more than two factors that influence the epidemiology of diseases, using more than one data source, should be considered in the predictions.
(7) Workforce calculations should consider the effects of medical development, either based on formal data or expert consensus.
(8) For a good forecasting model, the consideration of more than one economic factors for the national economic development of a country is recommended.
(9) No published data referenced; author assumes total prevalence of rheumatic diseases=prevalence of rheumatoid arthritis×5.
(10) The following conditions were summarised in the Modified Graduate Medical Education National Advisory Committee (GMENAC) list: gonococcal infection of joint, crystalline arthritis, psoriatic arthropathy, pyogenic arthritis, acute non-pyogenicarthritis, rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, residual arthritides, fibromyalgia, osteomyelitis, Paget’s disease, osteoporosis, disc displacement, neck and back pain, internal joint derangement, bursitis and tendinitis, connective tissue disease, other musculoskeletal disorders.
(11) Assumed a higher number of needed visits for psoriatic arthritis, pyogenic arthritis, RA, fibromyalgia and connective tissue disease; considered severity of disease.
(12) Rheumatoid arthritis, osteoarthritis, spondyloarthritis, polymyalgia rheumatica, lupus, low back pain, gout, osteoporosis.
(13) Partially cited means that sometimes published criteria were cited and sometimes not.
(14) Estimated according to the National Ambulatory Medical Care Survey (NAMCS): RA 52.0%, OA 7.0%, spondyloarthritis 77.3%, polymyalgia rheumatica 48.3%, lupus 29.9%, low back pain 2.9%, gout 11.7%, osteoporosis 5.1%.
(15) No published data referenced; author assumes a total prevalence of arthritis to be 19% in women and 11% in men.
(16) Polyarthritis, crystal arthropathies, connective tissue diseases, vasculitis, soft-tissue diseases, degenerative musculoskeletal diseases, osteoporosis.
(17) No published data referenced; author assumes a total prevalence of polyarthritis of 1%, crystal arthopathies 0.1%, connective tissue diseases 0.1%, vasculitis 0.05%, soft-tissue diseases 5% and degenerative musculoskeletal diseases 10%.
(18) Rheumatoid arthritis, spondyloarthritis, connective tissue disease, vasculitis, polyarticular secondary osteoarthritis, generalised pain syndromes.
(19) Author assumes total prevalence of rheumatic diseases to be 4%—estimate supported by several references ranging from local German studies to large studies from the USA.
(20) Undifferentiated arthritis, rheumatoid arthritis, spondyloarthritis, connective tissue diseases, vasculitis.
(21) Osteoarthritis, crystal arthropathies, suspected inflammatory back pain, fibromyalgia, bone diseases.
(22) No published data referenced; author assumes total prevalence of 2% for inflammatory rheumatic diseases and 10% for the other conditions described.
(23) Estimated amount and time for prevalent (4 visits×20min) and incident cases (1.5 visits×40 min) and also for co-consultation for other diseases. For the co-consultation, they assumed 10% of 26 000 severe cases per 100 000 inhabitants for co-consultation (2600 cases×15min).
(24) Rheumatoid arthritis, spondyloarthritis, osteoarthritis, other metabolic bone diseases, systemic autoimmune diseases, soft-tissue diseases, neck and back pain, fibromyalgia, crystal arthropathies, paediatric rheumatology, tumour and infectious pathologies, other pathologies.
(25) Rheumatoid arthritis, osteoarthritis, backache, connective tissue diseases, other rheumatic disorders.
(26) No published data referenced; author assumes total prevalence of ~2.7% for diseases.
(27) Musculoskeletal conditions, osteoarthritis-related joint pain, osteoporosis, back pain, rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus, scleroderma, gout, regional pain syndromes, chronic widespread pain, juvenile idiopathic arthritis.
(28) Rheumatoid arthritis, spondyloarthritis, systemic lupus erythematosus, systemic sclerosis, Sjogren’s syndrome, osteoarthritis, polymyalgia rheumatica, giant cell arteritis, gout, fibromyalgia.
(29) Report based on surveys and another two survey-based publications.
(30) Assumed that 25% of patients wents with OA are seen by a rheumatologist.
(31) No further specification.
(32) Rheumatoid arthritis, spondyloarthritis, crystal arthropathies, collagenosis, vasculitis.
(33) Zink A, Albrecht K (2016). Wie häufig sind muskuloskeletale Erkrankungen in Deutschland? Z Rheumatol 75:346–353.
(34) Assumed 10% of 18 million people (2600×15 min).
*Risk of bias related to the data source is taken into account in scoring of the respective factor
ACS, American Community Service; BRFSS, Behavioral Risk Factor Surveillance System; HRSA, Health Resources and Services Administration; ICD9-CM, International Classification of Diseases, Ninth Revision—Clinical Modification; NA, not applicable; NICE, National Institute for Health and Care Excellence; NNHS, National Nursing Home Survey; OA, osteoarthritis; RA, rheumatoid arthritis.
