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

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.