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Access to rheumatologists among patients with newly diagnosed rheumatoid arthritis in a Canadian universal public healthcare system
  1. Jessica Widdifield1,2,
  2. J Michael Paterson1,2,3,
  3. Sasha Bernatsky4,
  4. Karen Tu1,2,
  5. J Carter Thorne5,
  6. Noah Ivers1,2,6,
  7. Debra Butt1,
  8. R Liisa Jaakkimainen1,2,7,
  9. Nadia Gunraj2,
  10. Vandana Ahluwalia8,
  11. Claire Bombardier1
  1. 1University of Toronto, Toronto, Ontario, Canada
  2. 2Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
  3. 3McMaster University, Hamilton, Ontario, Canada
  4. 4McGill University, Montreal, Quebec, Canada
  5. 5Southlake Regional Health Centre, Newmarket, Ontario, Canada
  6. 6Women's College Hospital, Toronto, Ontario, Canada
  7. 7Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  8. 8William Osler Health Center, Brampton, Ontario, Canada
  1. Correspondence to Dr Jessica Widdifield; jessica.widdifield{at}


Objectives Our objective was to estimate the percentage of patients with incident rheumatoid arthritis (RA) who were seen by a rheumatologist within 3, 6 and 12 months of suspected diagnosis by a family physician, and assess what factors may influence the time frame with which patients are seen.

Setting Ontario, Canada.

Participants Over 2000–2009, we studied patients with incident RA who were initially diagnosed by a family physician.

Primary and secondary outcome measures We assessed secular trends in rheumatology encounters and differences between patients who received versus did not receive rheumatology care. We performed hierarchical logistic regression analyses to determine whether receipt of rheumatology care was associated with patient, primary care physician and geographical factors.

Results Among 19 760 patients with incident RA, 59%, 75% and 84% of patients were seen by a rheumatologist within 3, 6 and 12 months, respectively. The prevalence of initial consultations within 3 months did not increase over time; however, access within 6 and 12 months increased over time. Factors positively associated with timely consultations included higher regional rheumatology supply (adjusted OR (aOR) 1.35 (95% CI 1.13 to 1.60)) and higher patient socioeconomic status (aOR 1.18 (95% CI 1.07 to 1.30)). Conversely, factors inversely associated with timely consultations included remote patient residence (aOR 0.51 (95% CI 0.41 to 0.64)) and male family physicians (aOR 0.88 (95% CI 0.81 to 0.95)).

Conclusions Increasing access to rheumatologists within 6 and 12 months occurred over time; however, consultations within 3 months did not change over time. Measures of poor access (such as proximity to and density of rheumatologists) were negatively associated with timely consultations. Additional factors that contributed to disparities in access included patient socioeconomic status and physician sex.

  • Rheumatology

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