title: Visits to rheumatologists for arthritis: the role of access to primary care physicians, geographic availability of rheumatologists, and socioeconomic status.
abstract: OBJECTIVE
  This multilevel study examines access to rheumatologists for all arthritis and inflammatory arthritis, taking into account geographic availability of rheumatologists, access to primary care physicians (PCPs), and population characteristics (e.g., socioeconomic status [SES]).
  
  
  METHODS
  We analyzed data from the population (age ≥18 years) living in the 105 health planning areas in Ontario, Canada on visits to physicians for arthritis and musculoskeletal disorders. Using data from a survey of rheumatologists and Geographic Information System analysis, an index of geographic availability for rheumatologists was calculated, incorporating distance between the population and rheumatologist locations and the number of hours per week of rheumatologist care. Multilevel Poisson regression was used to examine factors associated with the rates of rheumatology visits for inflammatory arthritis and all arthritis.
  
  
  RESULTS
  Controlling for age and sex, the rheumatologist availability index was associated with visit rates for all arthritis, but not inflammatory arthritis. Patients living in areas with low access to PCPs or low SES were less likely to have office visits to rheumatologists for all arthritis and inflammatory arthritis.
  
  
  CONCLUSIONS
  Besides potential deficiencies in rheumatology provision, there may be access barriers to rheumatology services, particularly for populations with low access to PCPs or low SES. This is of special concern for patients with inflammatory arthritis for whom rheumatologist care is necessary. In developing models of care for arthritis, this study points to the need to pay attention to areas with low PCP resources and areas of low SES, as well as the location and amount of rheumatology services available.
authors.affiliation: Toronto Western Research Institute, University of Toronto, and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Badley
authors.forename: Mayilee
authors.initials: M
authors.lastname: Canizares
authors.forename: Anna C
authors.initials: AC
authors.lastname: Gunz
authors.forename: Aileen M
authors.initials: AM
authors.lastname: Davis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001168:Arthritis / Q000628:therapy*; D002170:Canada; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D058007:Physicians, Primary Care / Q000706:statistics & numerical data*; D012219:Rheumatology / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D055815:Young Adult