Ambulatory and hospital care for osteoarthritis and other musculoskeletal disorders in Ontario, Canada 8

Abstract

Purpose: Ontario, Canada (the most populous province, with over one-third of the Canadian population) has publicly funded, universal health insurance covering medically necessary hospital and physician services with no copayment fees. The objective of this study was to quantify the burden of osteoarthritis (OA) on the Ontario health care system, examining the magnitude of ambulatory physician care and hospital service use, considering different physician types (e.g. primary care, rheumatologists, orthopedic surgeons) and hospital settings (e.g. emergency department (ED), day surgery, inpatient hospitalizations). Analogous data were also examined for non-traumatic spine conditions, and all musculoskeletal disorders (MSDs) combined, including a comprehensive list of both trauma and non-trauma related conditions. Methods: Administrative health data were analyzed for fiscal year 2013/14 for adults aged 18+ years (N = 10,841,302). Data sources included: Ontario Health Insurance Plan (OHIP) Claims History Database, which captures data on in- and out-patient physician services; Canadian Institute for Health Information (CIHI) Discharge Abstract Database, which records diagnoses and procedures associated with all inpatient hospitalizations; and CIHI National Ambulatory Care Reporting System, which captures data on all emergency department (ED) and day surgery encounters. Services associated with OA and other MSDs were identified using the single three digit International Classification of Diseases (ICD) version 9 diagnosis code provided on each physician service claim for outpatient physician visits and the “most responsible” ICD-10 diagnosis code recorded for hospitalizations, ED visits and day surgeries. Patient visit rates and numbers of patients and visits were tabulated according to care setting, patient age and sex, and physician specialty for OA, non-traumatic spine conditions and all MSDs. Results: Overall, 3.1 million adult Ontarians (28.5%) made 8 million outpatient physician visits associated with MSDs in 2013/14. These included 5.6 million primary care visits, nearly 15% of all adult primary care visits in the province. MSDs accounted for 560,000, 12.3%, of all adult ED visits. Approximately 552,000 adult Ontarians (5%) made 1.1 million outpatient physician visits for OA. Patient visit rates to physicians for OA increased with age and were higher in women than men; women accounted for 61.7% of OA visits. Three quarters of those who saw a physician for OA saw a primary care physician at least once; 670,000 visits were in primary care accounting for 62.8% of all OA visits. Just over 25% of individuals who saw a physician for OA consulted an orthopaedic surgeon and 7% saw a rheumatologist at least once. About 106 per 100,000 adults also made a visit to an ED for which the most responsible diagnosis was OA. OA had the highest rate of inpatient hospitalization of all MSDs at 340 per 100,000 population, accounting for 42% of all MSD-related admissions. Just over half a million adults (5%) made a physician visit for a non-traumatic spine condition, including visits for back pain and spine OA, for a total of 1.1 million visits, with 83% of these visits occurring in primary care. Patient visit rates to the ED for these spine conditions were the highest of all MSDs at 1032 per 100,000 population, accounting for 23% of all MSD-related ED visits. Conclusions: MSDs generally, but in particular OA and non-traumatic spine conditions, place a significant and costly burden on the health care system. Findings highlight that much of the care for these conditions occurs in a primary care setting, though many affected individuals also make ED visits. As the population ages, it will be essential that health system planning takes into account the large and escalating demand for MSD care, both in terms of health human resources planning and the implementation of more clinically and cost effective models of care, to reduce both the individual and population burden.