System-level performance measures of access to rheumatology care: a population-based retrospective study of trends over time and the impact of regional rheumatologist supply in Ontario, Canada, 2002–2019
Abstract Objective To determine whether there were improvements in rheumatology care for rheumatoid arthritis (RA) between 2002 and 2019 in Ontario, Canada, and to evaluate the impact of rheumatologist regional supply on access. Methods We conducted a population-based retrospective study of all indi...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-12-01
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| Series: | BMC Rheumatology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s41927-022-00315-6 |
| _version_ | 1828083091041681408 |
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| author | Claire E. H. Barber Diane Lacaille Ruth Croxford Cheryl Barnabe Deborah A. Marshall Michal Abrahamowicz Hui Xie J. Antonio Avina-Zubieta John M. Esdaile Glen Hazlewood Peter Faris Steven Katz Paul MacMullan Dianne Mosher Jessica Widdifield |
| author_facet | Claire E. H. Barber Diane Lacaille Ruth Croxford Cheryl Barnabe Deborah A. Marshall Michal Abrahamowicz Hui Xie J. Antonio Avina-Zubieta John M. Esdaile Glen Hazlewood Peter Faris Steven Katz Paul MacMullan Dianne Mosher Jessica Widdifield |
| author_sort | Claire E. H. Barber |
| collection | DOAJ |
| description | Abstract Objective To determine whether there were improvements in rheumatology care for rheumatoid arthritis (RA) between 2002 and 2019 in Ontario, Canada, and to evaluate the impact of rheumatologist regional supply on access. Methods We conducted a population-based retrospective study of all individuals diagnosed with RA between January 1, 2002 and December 31, 2019. Performance measures evaluated were: (i) percentage of RA patients seen by a rheumatologist within one year of diagnosis; and (ii) percentage of individuals with RA aged 66 years and older (whose prescription drugs are publicly funded) dispensed a disease modifying anti-rheumatic drug (DMARD) within 30 days after initial rheumatologist visit. Logistic regression was used to assess whether performance improved over time and whether the improvements differed by rheumatology supply, dichotomized as < 1 rheumatologist per 75,000 adults versus ≥1 per 75,000. Results Among 112,494 incident RA patients, 84% saw a rheumatologist within one year: The percentage increased over time (adjusted odds ratio (OR) 2019 vs. 2002 = 1.43, p < 0.0001) and was consistently higher in regions with higher rheumatologist supply (OR = 1.73, 95% CI 1.67–1.80). Among seniors who were seen by a rheumatologist within 1 year of their diagnosis the likelihood of timely DMARD treatment was lower among individuals residing in regions with higher rheumatologist supply (OR = 0.90 95% CI 0.83–0.97). These trends persisted after adjusting for other covariates. Conclusion While access to rheumatologists and treatment improved over time, shortcomings remain, particularly for DMARD use. Patients residing in regions with higher rheumatology supply were more likely to access care but less likely to receive timely treatment. |
| first_indexed | 2024-04-11T04:04:15Z |
| format | Article |
| id | doaj.art-9065ce79d32a4547a448f385a03ffb25 |
| institution | Directory Open Access Journal |
| issn | 2520-1026 |
| language | English |
| last_indexed | 2024-04-11T04:04:15Z |
| publishDate | 2022-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Rheumatology |
| spelling | doaj.art-9065ce79d32a4547a448f385a03ffb252023-01-01T12:29:59ZengBMCBMC Rheumatology2520-10262022-12-016111010.1186/s41927-022-00315-6System-level performance measures of access to rheumatology care: a population-based retrospective study of trends over time and the impact of regional rheumatologist supply in Ontario, Canada, 2002–2019Claire E. H. Barber0Diane Lacaille1Ruth Croxford2Cheryl Barnabe3Deborah A. Marshall4Michal Abrahamowicz5Hui Xie6J. Antonio Avina-Zubieta7John M. Esdaile8Glen Hazlewood9Peter Faris10Steven Katz11Paul MacMullan12Dianne Mosher13Jessica Widdifield14Department of Medicine, University of CalgaryArthritis Research CanadaICESDepartment of Medicine, University of CalgaryDepartment of Medicine, University of CalgaryArthritis Research CanadaArthritis Research CanadaArthritis Research CanadaArthritis Research CanadaDepartment of Medicine, University of CalgaryAlberta Health ServicesDepartment of Medicine, University of AlbertaDepartment of Medicine, University of CalgaryDepartment of Medicine, University of CalgaryICESAbstract Objective To determine whether there were improvements in rheumatology care for rheumatoid arthritis (RA) between 2002 and 2019 in Ontario, Canada, and to evaluate the impact of rheumatologist regional supply on access. Methods We conducted a population-based retrospective study of all individuals diagnosed with RA between January 1, 2002 and December 31, 2019. Performance measures evaluated were: (i) percentage of RA patients seen by a rheumatologist within one year of diagnosis; and (ii) percentage of individuals with RA aged 66 years and older (whose prescription drugs are publicly funded) dispensed a disease modifying anti-rheumatic drug (DMARD) within 30 days after initial rheumatologist visit. Logistic regression was used to assess whether performance improved over time and whether the improvements differed by rheumatology supply, dichotomized as < 1 rheumatologist per 75,000 adults versus ≥1 per 75,000. Results Among 112,494 incident RA patients, 84% saw a rheumatologist within one year: The percentage increased over time (adjusted odds ratio (OR) 2019 vs. 2002 = 1.43, p < 0.0001) and was consistently higher in regions with higher rheumatologist supply (OR = 1.73, 95% CI 1.67–1.80). Among seniors who were seen by a rheumatologist within 1 year of their diagnosis the likelihood of timely DMARD treatment was lower among individuals residing in regions with higher rheumatologist supply (OR = 0.90 95% CI 0.83–0.97). These trends persisted after adjusting for other covariates. Conclusion While access to rheumatologists and treatment improved over time, shortcomings remain, particularly for DMARD use. Patients residing in regions with higher rheumatology supply were more likely to access care but less likely to receive timely treatment.https://doi.org/10.1186/s41927-022-00315-6Rheumatoid arthritisQuality careAccess to carePerformance measure |
| spellingShingle | Claire E. H. Barber Diane Lacaille Ruth Croxford Cheryl Barnabe Deborah A. Marshall Michal Abrahamowicz Hui Xie J. Antonio Avina-Zubieta John M. Esdaile Glen Hazlewood Peter Faris Steven Katz Paul MacMullan Dianne Mosher Jessica Widdifield System-level performance measures of access to rheumatology care: a population-based retrospective study of trends over time and the impact of regional rheumatologist supply in Ontario, Canada, 2002–2019 BMC Rheumatology Rheumatoid arthritis Quality care Access to care Performance measure |
| title | System-level performance measures of access to rheumatology care: a population-based retrospective study of trends over time and the impact of regional rheumatologist supply in Ontario, Canada, 2002–2019 |
| title_full | System-level performance measures of access to rheumatology care: a population-based retrospective study of trends over time and the impact of regional rheumatologist supply in Ontario, Canada, 2002–2019 |
| title_fullStr | System-level performance measures of access to rheumatology care: a population-based retrospective study of trends over time and the impact of regional rheumatologist supply in Ontario, Canada, 2002–2019 |
| title_full_unstemmed | System-level performance measures of access to rheumatology care: a population-based retrospective study of trends over time and the impact of regional rheumatologist supply in Ontario, Canada, 2002–2019 |
| title_short | System-level performance measures of access to rheumatology care: a population-based retrospective study of trends over time and the impact of regional rheumatologist supply in Ontario, Canada, 2002–2019 |
| title_sort | system level performance measures of access to rheumatology care a population based retrospective study of trends over time and the impact of regional rheumatologist supply in ontario canada 2002 2019 |
| topic | Rheumatoid arthritis Quality care Access to care Performance measure |
| url | https://doi.org/10.1186/s41927-022-00315-6 |
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