The opinions, results, and conclusions reported in this article are those of the authors and are independent from the funding sources.
Visits to Rheumatologists for Arthritis: The Role of Access to Primary Care Physicians, Geographic Availability of Rheumatologists, and Socioeconomic Status†
Article first published online: 27 JAN 2015
Copyright © 2015 by the American College of Rheumatology
Arthritis Care & Research
Volume 67, Issue 2, pages 230–239, February 2015
How to Cite
Badley, E. M., Canizares, M., Gunz, A. C. and Davis, A. M. (2015), Visits to Rheumatologists for Arthritis: The Role of Access to Primary Care Physicians, Geographic Availability of Rheumatologists, and Socioeconomic Status. Arthritis Care Res, 67: 230–239. doi: 10.1002/acr.22413
- Issue published online: 27 JAN 2015
- Article first published online: 27 JAN 2015
- Accepted manuscript online: 21 JUL 2014 12:43PM EST
- Manuscript Received: 26 SEP 2014
- Manuscript Accepted: 15 JUL 2014
- Canadian Institutes of Health Research Team Grant in Models of Care in Arthritis. Grant Number: grant ETG 92253
- Institute for Clinical Evaluative Sciences
- Ontario Ministry of Health and Long-Term Care
This multilevel study examines access to rheumatologists for all arthritis and inflammatory arthritis, taking into account geographic availability of rheumatologists, access to primary care physicians (PCPs), and population characteristics (e.g., socioeconomic status [SES]).
We analyzed data from the population (age ≥18 years) living in the 105 health planning areas in Ontario, Canada on visits to physicians for arthritis and musculoskeletal disorders. Using data from a survey of rheumatologists and Geographic Information System analysis, an index of geographic availability for rheumatologists was calculated, incorporating distance between the population and rheumatologist locations and the number of hours per week of rheumatologist care. Multilevel Poisson regression was used to examine factors associated with the rates of rheumatology visits for inflammatory arthritis and all arthritis.
Controlling for age and sex, the rheumatologist availability index was associated with visit rates for all arthritis, but not inflammatory arthritis. Patients living in areas with low access to PCPs or low SES were less likely to have office visits to rheumatologists for all arthritis and inflammatory arthritis.
Besides potential deficiencies in rheumatology provision, there may be access barriers to rheumatology services, particularly for populations with low access to PCPs or low SES. This is of special concern for patients with inflammatory arthritis for whom rheumatologist care is necessary. In developing models of care for arthritis, this study points to the need to pay attention to areas with low PCP resources and areas of low SES, as well as the location and amount of rheumatology services available.