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Canadian Journal of Public Health

, Volume 97, Issue 3, pp 210–213 | Cite as

The Relationship Between Local Availability and First-time Use of Specialists in an Arthritis Population

  • Eleanor BoyleEmail author
  • Elizabeth M. Badley
  • Richard H. Glazier
Article
  • 1 Downloads

Abstract

Objective: 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.

Methods: 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.

Results: 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.

Discussion: 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.

MeSH terms

Arthritis access to health care specialist medical 

Résumé

Objectif: Déterminer quels facteurs de santé, et plus particulièrement l’accès local à des spécialistes, sont associés au taux d’utilisation ambulatoire — ajusté selon l’âge et le sexe — des spécialistes de la santé musculosquelettique (rhumatologues, chirurgiens orthopédistes et internistes généralistes) au sein d’une cohorte d’individus souffrant d’arthrite et de rhumatisme (A/R).

Méthodologie: La cohorte est composée de répondants âgés de 15 ans ou plus qui, dans le cadre de l’Enquête sur la santé en Ontario de 1996–1997, ont déclaré souffrir d’arthrite ou de rhumatisme et/ou qui, selon un examen de la facturation de l’Assurance-santé de l’Ontario, avaient consulté en soins primaires pour des problèmes d’A/R au cours des deux années précédant la tenue de l’enquête. Nous n’avons pas tenu compte des répondants ayant déjà consulté un spécialiste des troubles musculosquelettiques. Le résultat d’une consultation auprès d’un spécialiste a été déterminé durant la période de trois ans suivant la tenue de l’enquête.

Résultats: La cohorte était composée de 5 052 répondants, dont 11 % avaient eu une rencontre avec un spécialiste pour un problème d’arthrite ou de rhumatisme au cours de la période de trois ans suivant l’enquête. La régression multiple descendante utilisée pour examiner les prédicteurs de consultation des spécialistes montre une association positive avec la disponibilité locale des rhumatologues, une association négative avec la proportion de diplômés du secondaire dans la région sanitaire et une association négative avec la proportion de personnes âgées de 65 ans ou plus.

Discussion: En ce qui concerne la région sanitaire, nous avons constaté que la disponibilité locale des rhumatologues constituait un facteur important dans le recours aux spécialistes pour le traitement des troubles d’arthrite et de rhumatisme chez une cohorte de répondants qui n’avaient pas auparavant consulté de spécialistes pour des troubles musculosquelettiques.

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Copyright information

© The Canadian Public Health Association 2006

Authors and Affiliations

  • Eleanor Boyle
    • 1
    Email author
  • Elizabeth M. Badley
    • 2
  • Richard H. Glazier
    • 3
  1. 1.Toronto Western Research Institute, Arthritis Community Research and Evaluation Unit, Institute of Medical SciencesUniversity of TorontoTorontoCanada
  2. 2.Toronto Western Research Institute, Arthritis Community Research and Evaluation Unit, Department of Public Health ScienceUniversity of TorontoCanada
  3. 3.Centre for Research on Inner City Health, St. Michael’s Hospital, Departments of Family and Community Medicine, and Public Health SciencesUniversity of TorontoCanada

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