The association of rheumatologist supply and multidisciplinary care with timely patient access to rheumatologists: Evidence from British Columbia, Canada
Norma K. Biln, Daphne Guh, Nick Bansback, Kam Shojania, Mark Harrison- Rheumatology
Objective
To understand how the expansion of rheumatology supply and the introduction of multidisciplinary care was associated with access to rheumatology services.
Method
We accessed Population Data BC, a longitudinal database with de‐identified individual‐level health data on all residents of British Columbia (BC), Canada, to analyse physician visits and prescribing from 2010/11 to 2019/20. We calculated access as the time from referral to first rheumatologist visit, and for people with rheumatoid arthritis (RA), time to first disease‐modifying anti‐rheumatic drug (DMARD). Associations between lag time, patient characteristics and system variables were explored using quantile regression.
Results
Over the study period, there were 149,902 new rheumatologist visits, with 31% more visits in 2019/20 than in 2010/11. The proportion of first‐visits for inflammatory arthritis (IA) patients increased from 28% to 51%. The median time from referral to first visit decreased by 22 days (35%) from 63 days (IQR 21‐120) in 2010/11. For people with RA, time from referral to DMARD decreased by 4 days (6%) to 62 days. Male sex, living in metropolitan areas, and having a rheumatologist who used a multidisciplinary care assessment code were associated with shorter times from referral to first DMARD.
Conclusion
Access to rheumatology care improved and the increased proportion of IA patients in the first‐visits case‐mix indicates that rheumatologist supply and incentives for multidisciplinary care may have improved referral patterns. However, time to DMARDs for people with RA remained long, and we found signals of unequal access for females and people living outside of metropolitan areas.