Utilisation and costs of investigations, and accuracy of diagnosis of polymyalgia rheumatica by family physicians

Abstract

To determine the utilisation and costs of investigations, and the accuracy of polymyalgia rheumatica (PMR) by family physicians, a retrospective chart review of 123 patients referred to a tertiary care rheumatology clinic was undertaken. The accuracy of diagnosis of PMR in the cohort was 24%. A variable number of investigations and costs occurred prior to referral, ranging from $110 in those with an unspecified locomotor diagnosis, through $74 in those with a correct diagnosis of PMR, to $24 where no diagnosis was entertained. In general, these costs were considered higher than necessary to make the diagnosis compared to those advocated by rheumatologists. We conclude that there is a low accuracy of diagnosis of PMR and an overutilisation of investigations, with resultant increased costs, by family physicians referring patients with PMR. Appropriate educational interventions are required to address both diagnostic and investigational needs.