Informing equitable access to care: a cross-sectional study of travel burden to primary and rheumatology care for people with rheumatoid arthritis.

IF 4.5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

International Journal for Equity in Health Pub Date : 2025-03-27 DOI:10.1186/s12939-025-02439-w

Xiaoxiao Liu, Alka B Patel, Judy E Seidel, Dianne P Mosher, John Hagens, Deborah A Marshall

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引用次数: 0

Abstract

Background: Achieving equity in access to care is a priority at both national and provincial levels in Canada to address health disparities. However, equitable access remains a challenge due to significantly higher rheumatoid arthritis (RA) prevalence in vast rural areas, whereas the RA care providers are primarily concentrated in the two largest cities. Rural-urban disparities in access may be partially attributed to geographic barriers. It is important to measure travel burden of people with RA for developing targeted interventions and policies to mitigate identified geographic barriers and informing equitable access to health care.

Methods: A cross-sectional study was conducted between April 1, 2019 and March 31, 2020 for people with RA in Alberta, Canada. RA cohort was identified using a validated RA case definition based on administrative health data. Travel time between patients' postal codes and providers' clinic postal codes was calculated using network analysis. Median travel time was reported at geographic area level. Wilcoxon Rank Sum Test was applied to test the statistical significance between rural-urban categories. The distance decay effect of travel time on health care utilizaton was modelled using a reverse cumulative probability approach.

Results: RA patients took a median of 13 min (IQR: 5-28) to visit general practitioners (GPs) and 34 min (IQR: 21-51) to visit rheumatologists. There were significant rural-urban disparities in access to GP and rheumatology care. The results showed a 4-fold difference in GP travel time (remote areas:5 min, IQR 5-79; moderate metro:20 min, IQR 7-34) and 8.7-fold difference to rheumatologist visit (remote: 226 min, IQR 165-331; metro: 26 min, IQR 17-36) across the rural-urban continuum. Remote patients experienced the longest travel time to rheumatology care but the shortest median travel time to GP care. In remote areas, travel time showed the weakest impact on health care utilization compared to other rural-urban continuum.

Conclusions: Measuring the travel burden for people with RA to access care reveals patterns about the differences in how far patients travelled to seek RA care based on their residential geographic location. These findings will provide evidence to inform health care planning and address observed disparities towards the goal of achieving equitable care.

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为公平获得医疗服务提供依据：关于类风湿关节炎患者前往基层医疗机构和风湿病医疗机构的旅行负担的横断面研究。

背景：在获得保健方面实现公平是加拿大国家和省一级解决保健差距的优先事项。然而，由于类风湿关节炎（RA）在广大农村地区的患病率明显较高，公平获取仍然是一个挑战，而类风湿关节炎护理提供者主要集中在两个最大的城市。城乡在获取方面的差异可能部分归因于地理障碍。衡量风湿性关节炎患者的旅行负担对于制定有针对性的干预措施和政策以减轻已确定的地理障碍并告知公平获得卫生保健非常重要。方法：在2019年4月1日至2020年3月31日期间，对加拿大阿尔伯塔省的RA患者进行了一项横断面研究。使用基于行政健康数据的有效RA病例定义确定RA队列。使用网络分析计算患者与提供者诊所邮编之间的旅行时间。旅行时间中位数按地理区域水平报告。采用Wilcoxon秩和检验检验城乡分类间的显著性。利用反向累积概率方法，建立了出行时间对医疗保健利用的距离衰减效应模型。结果：RA患者去看全科医生（gp）的平均时间为13分钟（IQR: 5-28），去看风湿病学家的平均时间为34分钟（IQR: 21-51）。在获得全科医生和风湿病护理方面存在显著的城乡差异。结果显示，两地GP出行时间相差4倍(偏远地区：5分钟，IQR 5-79；中度地铁：20分钟，IQR 7-34)和风湿病医生就诊的8.7倍差异(远程：226分钟，IQR 165-331；地铁：26分钟，IQR 17-36)跨越城乡连续体。偏远地区患者到风湿科就诊的路程最长，但到全科医生就诊的路程中值最短。在偏远地区，与其他城乡连续体相比，出行时间对医疗保健利用的影响最弱。结论：测量类风湿关节炎患者获得治疗的旅行负担揭示了基于居住地理位置的患者寻求类风湿关节炎治疗的路程差异模式。这些发现将为卫生保健规划提供证据，并解决为实现公平护理目标而观察到的差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal for Equity in Health Medicine-Health Policy

CiteScore

7.80

自引率

4.20%

发文量

162

审稿时长

28 weeks

期刊介绍： International Journal for Equity in Health is an Open Access, peer-reviewed, online journal presenting evidence relevant to the search for, and attainment of, equity in health across and within countries. International Journal for Equity in Health aims to improve the understanding of issues that influence the health of populations. This includes the discussion of political, policy-related, economic, social and health services-related influences, particularly with regard to systematic differences in distributions of one or more aspects of health in population groups defined demographically, geographically, or socially.