Background — 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. SES).
Methods — Analysis of data of the population (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 GIS 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's care. Multilevel Poisson regression was used to examine factors associated with the rates of rheumatology visits for inflammatory arthritis and all arthritis.
Results — 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.
Discussion — 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 PCPs resources and areas of low SES, as well as the location and amount of rheumatology services available.
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Access to health care
Social determinants of health