Article Text

Download PDFPDF

The pathway to orthopaedic surgery: a population study of the role of access to primary care and availability of orthopaedic services in Ontario, Canada
  1. Mayilee Canizares1,2,
  2. Aileen M Davis1,3,4,
  3. Elizabeth M Badley1,5,6
  1. 1The Arthritis Community Research and Evaluation Unit, Division of Health Care and Outcomes Research, Toronto Western Research Institute, Toronto, Ontario, Canada
  2. 2Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
  3. 3Department of Physical Therapy, Rehabilitation Science, University of Toronto, Toronto, Ontario, Canada
  4. 4Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  5. 5Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  6. 6Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
  1. Correspondence to Mayilee Canizares; mcanizar{at}uhnres.utoronto.ca

Abstract

Objective To examine the impact of access to primary care physicians (PCPs), geographic availability of orthopaedic surgeons, socioeconomic status (SES), proportion of older population (≥65 years) and proportion of rural population on orthopaedic surgeon office visits and orthopaedic surgery.

Design Population multilevel study.

Setting Ontario, Canada.

Participants Ontario residents 18 years or older who had visits to orthopaedic surgeons or an orthopaedic surgery for musculoskeletal disorders in 2007/2008.

Primary and secondary outcomes Office visits to orthopaedic surgeons and orthopaedic surgery.

Results Access to PCPs and the index of geographic availability of orthopaedic surgeons, but not SES, were significantly associated with orthopaedic surgeon office visits. There was a significant interaction between access to PCPs and orthopaedic surgeon geographic availability for the rate of office visits, with access to PCPs being more important in areas of low geographic availability of orthopaedic surgeons. After controlling for office visits with orthopaedic surgeons, the index of geographic availability of orthopaedic surgeons was no longer significantly associated with orthopaedic surgery.

Conclusions The findings suggest that, particularly, in areas with low access to PCPs or with fewer available orthopaedic surgeons, residents are less likely to have orthopaedic surgeon office visits and in turn are less likely to receive surgery. Efforts to address adequate access to orthopaedic surgery should also include improving and facilitating access to PCPs for referral, particularly in geographic areas with low orthopaedic surgeon availability.

  • Primary Care

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/

View Full Text

Statistics from Altmetric.com

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    Files in this Data Supplement:

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.