Area-level socioeconomic status impacts healthcare visit frequency by Australian inflammatory arthritis patients: results from the Australian Rheumatology Association Database.

IF 3.7 2区 医学 Q1 RHEUMATOLOGY
Oscar Russell, Susan Lester, Rachel J Black, Marissa Lassere, Claire Barrett, Lyn March, Tom Lynch, Rachelle Buchbinder, Catherine L Hill
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引用次数: 0

Abstract

Objective: Individuals with inflammatory arthritis (IA) require long-term rheumatologist care for optimal outcomes. We sought to determine if socioeconomic status (SES) influences general practitioner (GP) and specialist physician visit frequency and out of pocket (OOP) visit costs.

Methods: We linked data from Australian Rheumatology Association Database (ARAD) participants with rheumatoid arthritis or psoriatic arthritis to the Pharmaceutical Benefits (PBS) and Medicare Benefits Schedule (MBS) from 2011-2018. Small-area SES was approximated as quintiles of the Index of Relative Socieconomic Advantage and Disadvantage. A comorbidity index (Rx-Risk) was determined from PBS data. Analysis was performed using panel regression methods.

Results: We included 1916 ARAD participants (76.3% rheumatoid arthritis, 71.1% women, mean [SD] age 54 [12] years and disease duration 6 [4] years). Participants averaged 9.0 (95% CI 8.6, 9.4) annual GP visits and 3.9 (3.8 to 4.1) annual specialist physician visits. After adjustment for sex, age, education, remoteness and comorbidity, there was an inverse relationship between annual GP visit frequency and higher SES quintile (-0.6 [-0.9, -0.3] visits/quintile) and a direct relationship between more frequent specialist visits and higher SES (linear slope 0.3 [0.2, 0.5] visits/quintile). Average OOP costs/visit were higher for specialist physician (AUD$38.43 [37.34, 39.53] versus GP visits (AUD$7.86 [7.42, 8.31], and higher SES was associated with greater OOP cost.

Conclusion: Higher SES patients have relatively fewer GP visits and more specialist physician visits compared with lower SES patients, suggesting lower SES patients may receive suboptimal specialist physician care. OOP costs may be a contributing factor.

地区社会经济地位对澳大利亚炎症性关节炎患者就医频率的影响:澳大利亚风湿病学协会数据库的结果。
目的:炎症性关节炎(IA)患者需要风湿免疫科医生的长期治疗才能获得最佳疗效。我们试图确定社会经济地位(SES)是否会影响全科医生(GP)和专科医生的就诊频率以及自费(OOP)就诊费用:我们将澳大利亚风湿病学协会数据库(ARAD)中患有类风湿关节炎或银屑病关节炎的参与者的数据与2011-2018年的药品福利(PBS)和医疗保险福利表(MBS)进行了链接。小地区社会经济地位近似于社会经济相对优势和劣势指数的五分位数。并发症指数(Rx-Risk)由 PBS 数据确定。采用面板回归法进行分析:我们纳入了 1916 名 ARAD 参与者(76.3% 为类风湿性关节炎患者,71.1% 为女性,平均 [SD] 年龄为 54 [12] 岁,病程为 6 [4] 年)。参与者平均每年看全科医生 9.0 次(95% CI 8.6 至 9.4 次),每年看专科医生 3.9 次(3.8 至 4.1 次)。在对性别、年龄、教育程度、偏远地区和合并症进行调整后,全科医生年就诊次数与较高社会经济地位五分位数之间存在反向关系(-0.6 [-0.9, -0.3]次/五分位数),而专科医生就诊次数较多与较高社会经济地位之间存在直接关系(线性斜率为 0.3 [0.2, 0.5]次/五分位数)。专科医生(38.43 澳元 [37.34, 39.53])和全科医生(7.86 澳元 [7.42, 8.31])的平均门诊费用/次更高,SES 越高,门诊费用越高:结论:与社会经济地位较低的患者相比,社会经济地位较高的患者接受全科医生诊治的次数相对较少,而接受专科医生诊治的次数则相对较多,这表明社会经济地位较低的患者接受的专科医生诊治可能并不理想。门诊费用可能是其中一个因素。
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来源期刊
CiteScore
9.40
自引率
6.40%
发文量
368
审稿时长
3-6 weeks
期刊介绍: Arthritis Care & Research, an official journal of the American College of Rheumatology and the Association of Rheumatology Health Professionals (a division of the College), is a peer-reviewed publication that publishes original research, review articles, and editorials that promote excellence in the clinical practice of rheumatology. Relevant to the care of individuals with rheumatic diseases, major topics are evidence-based practice studies, clinical problems, practice guidelines, educational, social, and public health issues, health economics, health care policy, and future trends in rheumatology practice.
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