title: Assessing the need for improved access to rheumatology care: a survey of Massachusetts community health center medical directors.
abstract: OBJECTIVE
  Access to rheumatology care can expedite diagnosis and treatment of rheumatic diseases and reduce disparities. We surveyed community health center (CHC) medical directors to evaluate rheumatology care in underserved areas and potential strategies for improvement.
  
  
  METHODS
  We identified 77 Massachusetts CHCs that provide adult medical services and sent a 40-item survey to their physician medical directors. Survey questions assessed the centers' prevalence of rheumatic diseases, prescribing practices of immunosuppressive medications, and possible interventions to improve care. We compared CHC characteristics and rheumatology-specific items and then stratified our data by the response to whether improved access to rheumatology care was needed. Qualitative data were analyzed thematically.
  
  
  RESULTS
  Thirty-six CHC physician medical directors returned surveys (47% response rate). Fifty-five percent indicated a need for better access to rheumatology care. Eighty-six percent of CHC physicians would not start a patient with rheumatoid arthritis on a disease-modifying antirheumatic drug; 94% would not start a patient with systemic lupus erythematosus on an immunosuppressant. When we compared CHCs that reported needing better access to rheumatology care to those that did not, the former described a significantly greater percentage of patients with private insurance or Medicaid who required outside rheumatology referrals (P < 0.05). Language differences and insurance status were highlighted as barriers to obtaining rheumatology care. Sixteen directors (57%) ranked the patient navigator-a layperson to assist with care coordination-as their first-choice intervention.
  
  
  CONCLUSIONS
  Community health center medical directors expressed a need for better access to rheumatology services. A patient navigator for rheumatic diseases was proposed to help improve care and reduce health disparities.
authors.affiliation: From the *Brigham and Women's Hospital, Division of Rheumatology, Immunology and Allergy, Boston; †University of Massachusetts Memorial Medical Center, Division of Hospital Medicine, Worcester; and ‡Center for Community Health Education Research and Service, Inc; and §Division of Pharmacoepidemiology, Brigham and Women's Hospital, Boston, MA.
authors.forename: Candace H
authors.initials: CH
authors.lastname: Feldman
authors.forename: LeRoi S
authors.initials: LS
authors.lastname: Hicks
authors.forename: Tabatha L
authors.initials: TL
authors.lastname: Norton
authors.forename: Elmer
authors.initials: E
authors.lastname: Freeman
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Solomon
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use; D003151:Community Health Centers / Q000706:statistics & numerical data*; D003625:Data Collection; D006297:Health Services Accessibility / Q000639:trends*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007348:Insurance, Health / Q000706:statistics & numerical data; D008404:Massachusetts / Q000453:epidemiology; D006278:Medicare / Q000706:statistics & numerical data; D008486:Physician Executives / Q000706:statistics & numerical data*; D012216:Rheumatic Diseases / Q000188:drug therapy* / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014481:United States
chemical_list: D018501:Antirheumatic Agents; D007166:Immunosuppressive Agents
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