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Accuracy of Canadian health administrative databases in identifying patients with rheumatoid arthritis: a validation study using the medical records of rheumatologists.

https://arctichealth.org/en/permalink/ahliterature114676
Source
Arthritis Care Res (Hoboken). 2013 Oct;65(10):1582-91
Publication Type
Article
Date
Oct-2013
Author
Jessica Widdifield
Sasha Bernatsky
J Michael Paterson
Karen Tu
Ryan Ng
J Carter Thorne
Janet E Pope
Claire Bombardier
Author Affiliation
University of Toronto, Toronto, Ontario, Canada.
Source
Arthritis Care Res (Hoboken). 2013 Oct;65(10):1582-91
Date
Oct-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Algorithms
Arthritis, Rheumatoid - diagnosis - epidemiology
Data Mining - statistics & numerical data
Databases, Factual - statistics & numerical data
Drug Prescriptions - statistics & numerical data
Fees and Charges - statistics & numerical data
Female
Hospitalization - statistics & numerical data
Humans
Male
Medical Records Systems, Computerized - statistics & numerical data
Middle Aged
Ontario - epidemiology
Reproducibility of Results
Retrospective Studies
Rheumatology - statistics & numerical data
Single-Payer System - statistics & numerical data
Abstract
Health administrative data can be a valuable tool for disease surveillance and research. Few studies have rigorously evaluated the accuracy of administrative databases for identifying rheumatoid arthritis (RA) patients. Our aim was to validate administrative data algorithms to identify RA patients in Ontario, Canada.
We performed a retrospective review of a random sample of 450 patients from 18 rheumatology clinics. Using rheumatologist-reported diagnosis as the reference standard, we tested and validated different combinations of physician billing, hospitalization, and pharmacy data.
One hundred forty-nine rheumatology patients were classified as having RA and 301 were classified as not having RA based on our reference standard definition (study RA prevalence 33%). Overall, algorithms that included physician billings had excellent sensitivity (range 94-100%). Specificity and positive predictive value (PPV) were modest to excellent and increased when algorithms included multiple physician claims or specialist claims. The addition of RA medications did not significantly improve algorithm performance. The algorithm of "(1 hospitalization RA code ever) OR (3 physician RA diagnosis codes [claims] with =1 by a specialist in a 2-year period)" had a sensitivity of 97%, specificity of 85%, PPV of 76%, and negative predictive value of 98%. Most RA patients (84%) had an RA diagnosis code present in the administrative data within ±1 year of a rheumatologist's documented diagnosis date.
We demonstrated that administrative data can be used to identify RA patients with a high degree of accuracy. RA diagnosis date and disease duration are fairly well estimated from administrative data in jurisdictions of universal health care insurance.
PubMed ID
23592598 View in PubMed
Less detail

Ambulatory physician care for musculoskeletal disorders in Canada.

https://arctichealth.org/en/permalink/ahliterature171297
Source
J Rheumatol. 2006 Jan;33(1):133-9
Publication Type
Article
Date
Jan-2006
Author
J Denise Power
Anthony V Perruccio
Marie Desmeules
Claudia Lagacé
Elizabeth M Badley
Author Affiliation
Arthritis Community Research and Evaluation Unit (ACREU), Toronto Western Research Institute, University Health Network, Toronto.
Source
J Rheumatol. 2006 Jan;33(1):133-9
Date
Jan-2006
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Ambulatory Care - statistics & numerical data - utilization
Canada
Female
Humans
Male
Middle Aged
Musculoskeletal Diseases - therapy
Office Visits - statistics & numerical data - utilization
Physicians, Family - statistics & numerical data - utilization
Referral and Consultation
Rheumatology - statistics & numerical data
Abstract
To examine patterns of ambulatory physician visits for musculoskeletal disorders (MSD) in Canada.
Physician claims data from 7 provinces were analyzed for ambulatory visits made by adults age >or= 15 years to primary care physicians and specialists (all medical specialists, rheumatologists, internists, all surgical specialists, orthopedic surgeons) for MSD (arthritis and related conditions, bone disorders, back disorders, ill defined symptoms) during fiscal year 1998-99. Person-visit rates and total and mean number of visits to all physicians for MSD were calculated by condition group. The percentages of patients with MSD seeing physicians of different specialties were also calculated. Provincial data were combined to calculate national estimates.
Over 15.5 million physician visits were made for MSD during 1998-99. About 24% of Canadians made at least one physician visit for MSD: 16% for arthritis and related conditions, 2% for bone disorders, 7% for back disorders, and 6% for ill defined symptoms. Person-visit rates for MSD varied by province, were highest among older Canadians, and were greater for women than men. Primary care physicians were commonly seen, particularly for back disorders. Consultation with surgical and medical specialists was less common and varied by province and by condition.
MSD place a significant burden on Canada's ambulatory healthcare system. As the population ages, there will be an escalating demand for care. Careful planning will be required to ensure that those affected have access to the care they require. A limitation in using administrative data to examine health service utilization is that MSD diagnostic codes require validation.
Notes
Comment In: J Rheumatol. 2006 Jan;33(1):4-516395743
PubMed ID
16395761 View in PubMed
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A Canadian survey on the management of corticosteroid induced osteoporosis by rheumatologists.

https://arctichealth.org/en/permalink/ahliterature198242
Source
J Rheumatol. 2000 Jun;27(6):1506-12
Publication Type
Article
Date
Jun-2000
Author
E. Soucy
N. Bellamy
J D Adachi
J E Pope
J. Flynn
E. Sutton
J. Campbell
Author Affiliation
Department of Medicine, University of Western Ontario, London, Canada.
Source
J Rheumatol. 2000 Jun;27(6):1506-12
Date
Jun-2000
Language
English
Publication Type
Article
Keywords
Absorptiometry, Photon - statistics & numerical data
Adrenal Cortex Hormones - adverse effects
Adult
Alendronate - therapeutic use
Bone Density
Calcitonin - therapeutic use
Canada
Data Collection
Etidronic Acid - therapeutic use
Female
Hormone Replacement Therapy
Humans
Middle Aged
Osteoporosis - chemically induced - drug therapy - prevention & control - radiography
Physician's Practice Patterns
Postmenopause
Practice Management, Medical
Premenopause
Questionnaires
Referral and Consultation - statistics & numerical data
Rheumatology - statistics & numerical data
Abstract
To survey the practice pattern of Canadian rheumatologists (CR) on their management of corticosteroid induced osteoporosis in their premenopausal (PrM) and postmenopausal (PoM) female patients.
The practice pattern was surveyed using a 17 item questionnaire probing the diagnosis, prevention, treatment, and monitoring of osteoporosis in PrM and PoM women receiving longterm oral systemic corticosteroid therapy.
Most CR investigated and treated osteoporosis themselves, 13% referred to other specialists for investigation, and 22% referred for treatment. Eighty-two percent of CR used dual energy x-ray absorptiometry (DEXA) to confirm a diagnosis of osteoporosis. Most CR initiated investigation for osteoporosis at the start or within the first year of starting longterm systemic corticosteroid therapy: PrM 87% and PoM 93%. The most frequently used initial strategy for the prevention of osteoporosis was as follows. PrM: calcium and vitamin D3 (53%); PoM: hormone replacement therapy (HRT) and calcium (29%). The most common initial choice for treatment of established osteoporosis was as follows: PrM: etidronate (53%); PoM: bisphosphonates +/- HRT (53%). Ninety-six percent of CR used only bone mineral density (BMD) measurement to monitor therapy for corticosteroid induced osteoporosis. Most CR monitored BMD every 12 to 24 months for PrM (81%) and PoM (84%). The BMD parameter(s) (T and Z scores as measured by DEXA) used to initiate therapy for corticosteroid induced osteoporosis was variable.
It appears that, while certain trends are evident, there is still considerable variability in the management of corticosteroid induced osteoporosis.
PubMed ID
10852279 View in PubMed
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Co-morbidity and physician use in fibromyalgia.

https://arctichealth.org/en/permalink/ahliterature176045
Source
Swiss Med Wkly. 2005 Feb 5;135(5-6):76-81
Publication Type
Article
Date
Feb-5-2005
Author
S. Bernatsky
P L Dobkin
M. De Civita
J R Penrod
Author Affiliation
Division of Clinical Epidemiology, McGill University Health Center, Montreal, Quebec, Canada.
Source
Swiss Med Wkly. 2005 Feb 5;135(5-6):76-81
Date
Feb-5-2005
Language
English
Publication Type
Article
Keywords
Canada - epidemiology
Cardiovascular Diseases - epidemiology
Community Health Services - utilization
Comorbidity
Diabetes Mellitus - epidemiology
Female
Fibromyalgia - epidemiology
Health Care Surveys
Health Surveys
Humans
Mental Disorders - epidemiology
Middle Aged
Models, Statistical
Pain - epidemiology
Regression Analysis
Rheumatology - statistics & numerical data
Women's health
Abstract
To describe comorbidity in women with FM, and to examine the effects of different types of comorbidity on physician use.
Women (n = 180) with primary FM were evaluated at baseline and 6 months later for self-reported health resource use and covariates. Reported comorbidity was classified into 4 categories: medical, psychiatric, "functional", and unknown. The category for "functional" conditions included disorders that have been classified by previous authors as medically unexplained symptoms such as the irritable bowel and chronic fatigue syndromes. Logistic regression models were developed to examine associations between types of comorbidity and physician use.
Comorbid conditions were reported by over 90% of the sample. Total number of comorbid complaints was associated with high number of physician visits. In logistic regression models (controlling for age, ethnicity, education, disability, pain, and psychological vulnerability) medical comorbidity was a much stronger determinant of high number of physician visits than was "functional" comorbidity.
Comorbidity with other disorders, both functional and medical, was high in this sample. Medical and psychiatric comorbidity were stronger determinants of high physician use than "functional" comorbidity.
PubMed ID
15729611 View in PubMed
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Delay in consultation with specialists for persons with suspected new-onset rheumatoid arthritis: a population-based study.

https://arctichealth.org/en/permalink/ahliterature160055
Source
Arthritis Rheum. 2007 Dec 15;57(8):1419-25
Publication Type
Article
Date
Dec-15-2007
Author
Debbie Ehrmann Feldman
Sasha Bernatsky
Jeannie Haggerty
Karen Leffondré
Pierre Tousignant
Yves Roy
Yongling Xiao
Michel Zummer
Michal Abrahamowicz
Author Affiliation
Université de Montréal and Public Health Department of Montréal, Montréal, Québec, Canada.
Source
Arthritis Rheum. 2007 Dec 15;57(8):1419-25
Date
Dec-15-2007
Language
English
Publication Type
Article
Keywords
Aged
Arthritis, Rheumatoid - therapy
Disease Progression
Female
Health Surveys
Humans
Male
Middle Aged
Outcome Assessment (Health Care) - trends
Quebec
Referral and Consultation - statistics & numerical data
Regression Analysis
Rheumatology - statistics & numerical data
Sex Factors
Social Class
Specialization - statistics & numerical data
Time Factors
Treatment Outcome
Abstract
Care in rheumatoid arthritis (RA) is optimized by involvement of rheumatologists. We wished to determine whether patients suspected of having new-onset RA in Québec consulted with a rheumatologist, to document any delay in these consultations, and to determine factors associated with prompt consultation.
Physician reimbursement administrative data were obtained for all adults in Québec. Suspected new-onset cases of RA in the year 2000 were defined operationally as a physician visit for RA (based on the International Classification of Diseases, Ninth Revision diagnostic codes), where there had been no prior visit code to any physician for RA in the preceding 3 years. For those patients who were first diagnosed by a nonrheumatologist, Cox regression modeling was used to identify patient and physician characteristics associated with time to consultation with a rheumatologist.
Of the 10,001 persons coded as incident RA by a nonrheumatologist, only 27.3% consulted a rheumatologist within the next 2.5-3.5 years. Of those who consulted, the median time from initial visit to a physician for RA to consultation with a rheumatologist was 79 days. The strongest predictors of shorter time to consultation were female sex, younger age, being in a higher socioeconomic class, and having greater comorbidity.
Our data suggest that the vast majority of patients suspected of having new-onset RA do not receive rheumatology care. Further action should focus on this issue so that outcomes in RA may be optimized.
PubMed ID
18050182 View in PubMed
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Early consultation with a rheumatologist for RA: does it reduce subsequent use of orthopaedic surgery?

https://arctichealth.org/en/permalink/ahliterature120988
Source
Rheumatology (Oxford). 2013 Mar;52(3):452-9
Publication Type
Article
Date
Mar-2013
Author
Debbie Ehrmann Feldman
Sasha Bernatsky
Michelle Houde
Marie-Eve Beauchamp
Michal Abrahamowicz
Author Affiliation
CRIR, IRSPUM, Université de Montréal, Montréal, Québec H3C 3J7, Canada. debbie.feldman@umontreal.ca
Source
Rheumatology (Oxford). 2013 Mar;52(3):452-9
Date
Mar-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Arthritis, Rheumatoid - surgery - therapy
Cohort Studies
Disease Progression
Early Medical Intervention - statistics & numerical data
Female
Follow-Up Studies
Humans
Male
Middle Aged
Orthopedic Procedures - utilization
Proportional Hazards Models
Quebec
Referral and Consultation - statistics & numerical data
Retrospective Studies
Rheumatology - statistics & numerical data
Time Factors
Abstract
Optimal care in RA includes early use of DMARDs to prevent joint damage and hopefully decrease the need for costly surgical interventions. Our objective was to determine whether a reduced rate of orthopaedic surgery was evident for persons with RA who saw a rheumatologist early in the disease course.
We studied persons who had a diagnosis of RA based on billing code data in the province of Quebec in 1995, and for whom the initial date of RA diagnosis by a non-rheumatologist could be established before the confirmatory diagnosis by the rheumatologist. We followed these patients until 2007. Patients were classified as early consulters or late consulters depending on whether they were seen by a rheumatologist within or beyond 3 months of being diagnosed with RA by their referring physician. The outcome, orthopaedic surgery, was defined using International Classification of Diseases (ICD) procedure codes ICD9 and ICD10. Multivariate Cox regression with time-dependent covariates estimated the effect of early consultation on the time to orthopaedic surgery.
Our cohort consisted of 1051 persons; mean age at diagnosis was 55.7 years, 68.2% were female and 50.7% were early consulters. Among all patients, 20.5% (215) had an orthopaedic surgery during the observation interval. Early consulters were less likely to undergo orthopaedic surgery during the 12-year follow-up period (adjusted hazard ratio 0.60, 95% CI 0.44, 0.82).
Persons with RA who consult a rheumatologist later in the disease course have a worse outcome in terms of eventual requirement for orthopaedic surgery.
Notes
Comment In: Rheumatology (Oxford). 2013 Mar;52(3):411-223086516
PubMed ID
22949726 View in PubMed
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Evaluating practice patterns for managing moderate to severe plaque psoriasis: role of the family physician.

https://arctichealth.org/en/permalink/ahliterature121968
Source
Can Fam Physician. 2012 Jul;58(7):e390-400
Publication Type
Article
Date
Jul-2012
Author
Yves Poulin
Norman Wasel
Daphne Chan
Geula Bernstein
Robin Andrew
Elisa Fraquelli
Kim Papp
Author Affiliation
Centre de Recherche Dermatologique du Québec métropolitain, 105-2880 chemin Quatre-Bourgeois, Quebec, QC, Canada. poulinyves@videotron.ca
Source
Can Fam Physician. 2012 Jul;58(7):e390-400
Date
Jul-2012
Language
English
Publication Type
Article
Keywords
Canada
Cross-Sectional Studies
Dermatology - statistics & numerical data
Family Practice - statistics & numerical data
Female
Humans
Male
Middle Aged
Patient satisfaction
Physician's Practice Patterns - statistics & numerical data
Physician's Role
Psoriasis - therapy
Rheumatology - statistics & numerical data
Abstract
To describe practice patterns for care of Canadian patients with moderate to severe plaque psoriasis.
Online survey of a consumer panel.
Participants were drawn from a population-wide Canadian consumer database.
To be eligible to participate, respondents had to have been diagnosed with plaque psoriasis within the past 5 years, and to have had body surface area involvement of 3% or greater in the past 5 years, or to have psoriasis on a sensitive area of the body (hands, feet, scalp, face, or genitals), or to be currently receiving treatment with systemic agents or phototherapy for psoriasis.
Proportion of respondents with psoriasis managed by FPs and other specialists, psoriasis therapies, comorbidities, and patient satisfaction.
Invitations were sent to 3845 panelists with self-reported psoriasis, of which 514 qualified to complete the survey. Family physicians were reported to be the primary providers for diagnosis and ongoing care of psoriasis in all provinces except Quebec. Overall physician care was reported to be satisfactory by 62% of respondents. Most respondents receiving over-the-counter therapies (55%) or prescribed topical therapies (61%) reported that their psoriasis was managed by FPs. Respondents receiving prescription oral or injectable medications or phototherapy were mainly managed by dermatologists (42%, 74%, and 71% of respondents, respectively). Ongoing management of respondents with body surface area involvement of 10% or greater was mainly split between dermatologists (47%) and FPs (45%), compared with rheumatologists (4%) or other health care professionals (4%). Of those respondents receiving medications for concomitant health conditions, treatment for high blood pressure was most common (92%), followed by treatment for heart disease (75%) and elevated cholesterol and lipid levels (68%).
Patient-reported practice patterns for the diagnosis and management of moderate to severe psoriasis vary among provinces and in primary and secondary care settings.
Notes
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PubMed ID
22859642 View in PubMed
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Factors influencing rheumatologists' prescription of biological treatment in rheumatoid arthritis: an interview study.

https://arctichealth.org/en/permalink/ahliterature264646
Source
Implement Sci. 2014;9:153
Publication Type
Article
Date
2014
Author
Almina Kalkan
Kerstin Roback
Eva Hallert
Per Carlsson
Source
Implement Sci. 2014;9:153
Date
2014
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antirheumatic Agents - therapeutic use
Arthritis, Rheumatoid - drug therapy
Attitude of Health Personnel
Biological Factors - therapeutic use
Drug Costs
Drug Prescriptions - statistics & numerical data
Female
Humans
Male
Middle Aged
Physician's Practice Patterns - statistics & numerical data
Physician-Patient Relations
Questionnaires
Rheumatology - statistics & numerical data
Sweden
Abstract
The introduction of biological drugs involved a fundamental change in the treatment of rheumatoid arthritis (RA). The extent to which biological drugs are prescribed to RA patients in different regions in Sweden varies greatly. Previous research has indicated that differences in health care practice at the regional level might obscure differences at the individual level. The objective of this study is to explore what influences individual rheumatologists' decisions when prescribing biological drugs.
Semi-structured interviews, utilizing closed- and open-ended questions, were conducted with senior rheumatologists, selected through a mix of random and purposive sampling. The interview questions consisted of two parts, with a "parallel mixed method" approach. In the first and main part, open-ended exploratory questions were posed about factors influencing prescription. In the second part, the rheumatologists were asked to rate predefined factors that might influence their prescription decisions. The Consolidated Framework for Implementation Research (CFIR) was used as a conceptual framework for data collection and analysis.
Twenty-six rheumatologists were interviewed. A constellation of various factors and their interaction influenced rheumatologists' prescribing decisions, including the individual rheumatologist's experiences and perceptions of the evidence, the structure of the department including responsibility for costs, peer pressure, political and administrative influences, and participation in clinical trials. The patient as an actor emerged as an important factor. Hence, factors both at organizational and individual levels influenced the prescribing of biological drugs. The factors should not be seen as individual influences but were described as influencing prescription in an interactive, nonlinear way.
Potential factors explaining differences in prescription practice are experience and perception of the evidence on the individual level and the structure of the department and participation in clinical trials on the organizational level. The influence of patient attitudes and preferences and interpretation of scientific evidence seemed to be somewhat contradictory in the qualitative responses as compared to the quantitative rating, and this needs further exploration. An implication of the present study is that in addition to scientific knowledge, attempts to influence prescription behavior need to be multifactorial and account for interactions of factors between different actors.
Notes
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PubMed ID
25304517 View in PubMed
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Longitudinal analysis of a pediatric rheumatology clinic population.

https://arctichealth.org/en/permalink/ahliterature172569
Source
J Rheumatol. 2005 Oct;32(10):1992-2001
Publication Type
Article
Date
Oct-2005
Author
Alan M Rosenberg
Author Affiliation
Section of Rheumatology, Department of Pediatrics, University of Saskatchewan, Royal University Hospital, 103 Hospital Drive, Saskatoon, Saskatchewan S7N 0W8, Canada. rosenberg@sask.usask.ca
Source
J Rheumatol. 2005 Oct;32(10):1992-2001
Date
Oct-2005
Language
English
Publication Type
Article
Keywords
Adolescent
Ambulatory Care Facilities
Canada - epidemiology
Child
Child, Preschool
Comorbidity
Female
Humans
Infant
Infant, Newborn
Male
Pediatrics - statistics & numerical data - trends
Prospective Studies
Registries
Rheumatic Diseases - diagnosis - epidemiology
Rheumatology - statistics & numerical data - trends
Abstract
To analyze a prospectively maintained pediatric rheumatology clinic disease registry.
A total of 3269 consecutive referrals to the Pediatric Rheumatology Clinic, University of Saskatchewan, during the period 1981-2004 were analyzed.
Among 3269 patients, a diagnosis was established in 2098 (64.2%). Within this group, 72 subjects (3.4%) were determined to be healthy. Of the remaining 2026 diagnosed patients (62.0% of the total population), 1032 (50.9%) had a rheumatic disease and 994 (49.1%) a nonrheumatic disease. A diagnosis was not established in 1171 patients (35.8%). Among the 1032 patients with a rheumatic disease, 326 (31.6%) had juvenile rheumatoid arthritis (JRA), 360 (34.9%) a spondyloarthropathy (SpA), and 225 (21.8%) a collagen vascular/connective tissue rheumatic disease. The remaining 121 patients with a rheumatic disease (11.7%) had a variety of other conditions. Of the 994 nonrheumatic disease patients, 37 (3.7%) with ocular inflammatory conditions had been referred to exclude an associated rheumatic disease. The remaining group of 957 patients comprised 345 (36.1%) with an orthopedic, mechanical or traumatic condition, 231 (24.1%) had an infection, 45 (4.7%) a hematologic or neoplastic disease, and 336 (35.1%) a variety of other conditions. Current clinic point prevalences for JRA, SpA, and collagen vascular diseases are 35.0, 16.9 and 17.7/100,000, respectively. The mean annual clinic referral incidences of JRA, SpA, and collagen vascular/connective tissue diseases were, respectively, 4.7, 5.2, and 1.7/100,000 children.
Disease registries help establish the frequencies and spectrum of childhood rheumatic diseases and the role of pediatric rheumatology programs in evaluating and caring for children with a wide variety of conditions. Longitudinal disease registries aid in characterizing clinical, epidemiologic, and demographic features of childhood rheumatic diseases.
PubMed ID
16206357 View in PubMed
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The relationship between local availability and first-time use of specialists in an arthritis population.

https://arctichealth.org/en/permalink/ahliterature168397
Source
Can J Public Health. 2006 May-Jun;97(3):210-3
Publication Type
Article
Author
Eleanor Boyle
Elizabeth M Badley
Richard H Glazier
Author Affiliation
Toronto Western Research Institute, Arthritis Community Research and Evaluation Unit, Institute of Medical Sciences, University of Toronto, ON. Eleanor.boyle@uhn.on.ca
Source
Can J Public Health. 2006 May-Jun;97(3):210-3
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Arthritis - therapy
Cohort Studies
Female
Health Care Surveys
Health Services Accessibility - statistics & numerical data
Humans
Internal Medicine - statistics & numerical data
Logistic Models
Male
Middle Aged
Ontario
Orthopedics - statistics & numerical data
Outcome Assessment (Health Care)
Patient Acceptance of Health Care - statistics & numerical data
Rheumatic Diseases - therapy
Rheumatology - statistics & numerical data
Abstract
To determine what health area characteristics, in particular local availability of specialists, were associated with the age-sex adjusted ambulatory utilization rate of musculoskeletal (MSK) specialists (i.e., rheumatologists, orthopaedic surgeons and general internists) in an arthritis and rheumatism (A&R) cohort.
The cohort was composed of respondents aged 15+ from the 1996/97 Ontario Health Survey who self-reported A&R and/or had a primary care encounter for A&R during the two years preceding the survey, as determined by their billings in the Ontario Health Insurance Plan. Respondents with prior exposure to MSK specialists were excluded. The outcome of an encounter with a MSK specialist for A&R was determined during the three-year period after the survey.
The A&R cohort was composed of 5,052 respondents, of whom 11% had an A&R encounter with a MSK specialist in the three-year post-survey period. There was area variation in the age-sex adjusted ambulatory utilization rate of MSK specialists in the A&R cohort. The backwards stepping linear regression to examine predictors for seeing MSK specialists found a positive association with local availability of rheumatologists, a negative association with the proportion of high school graduates in the health area and a negative association with the proportion of people aged 65 years and older.
At the health area level, we found that the local availability of rheumatologists was an important factor associated with utilizing MSK specialists for A&R-related conditions in a cohort of respondents who have not been previously exposed to MSK specialists for musculoskeletal-related conditions.
PubMed ID
16827408 View in PubMed
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