title: Factors associated with access to rheumatologists for Medicare patients.
abstract: OBJECTIVE
  Despite looming rheumatologist shortages and a growing number of patients with arthritis and other rheumatic conditions, nationwide estimates of access to rheumatology care have never been reported. We aimed to measure travel times as a proxy to access to care and to determine the individual and area-level factors associated with long travel times to rheumatologists in the U.S.
  
  
  METHODS
  We used Medicare Part B claims for the 2009 Medicare Chronic Condition Warehouse 5% rheumatoid arthritis/osteoarthritis cohort. Using Google Maps we estimated driving time from the center of a beneficiary's home ZIP code to the center of their rheumatologist's office ZIP code. We examined predictors of travel time ≥90 min in a series of generalized linear mixed models adjusting for rheumatologist supply, rurality, and individual patient characteristics including age, race, gender, and income.
  
  
  RESULTS
  We included 41,693 Medicare beneficiaries with 1 or more visits to a rheumatologist in 2009. The median estimated beneficiary travel time to a rheumatologist was 22 min [interquartile range (IQR): 12-40 min]. Overall, 7% of beneficiaries traveled 90 min or longer to visit a rheumatologist. Even after adjusting for covariates, independent predictors of long travel times included living in areas with no or low supply of rheumatologists and living in the Mountain region of the U.S.
  
  
  CONCLUSIONS
  A small but significant proportion of patients in the U.S. traveled very long distances to visit a rheumatologist, and most of these individuals resided in areas with no or low supplies of rheumatologists. These data suggest that addressing shortages in rheumatology care for patients in low-supply areas is a key target for improving access to rheumatologists.
authors: Veterans Affairs Medical Center-San Francisco, 4150 Clement St, Mailstop 111R, San Francisco, CA 94121; Division of Rheumatology, University of California-San Francisco, San Francisco, CA. Electronic address: gabriela.schmajuk@ucsf.edu.
authors: Gabriela
authors: G
authors: Schmajuk
authors: Institute for Health Policy Studies, University of California, San Francisco, CA.
authors: Chris
authors: C
authors: Tonner
authors: Division of Rheumatology, University of California-San Francisco, San Francisco, CA.
authors: Jinoos
authors: J
authors: Yazdany
mesh_terms: D006297:Health Services Accessibility; D006801:Humans; D006278:Medicare; D012216:Rheumatic Diseases / Q000628:therapy*; D000072140:Rheumatologists; D012219:Rheumatology; D014481:United States
keywords: Access to care; Distance; Rheumatology