Characteristic | Seen by a rheumatologist | Multivariate analysis | ||
---|---|---|---|---|
Yes | No | Crude OR | Adjusted*OR | |
n=11 694 | N=8066 | (95% CI) | (95% CI) | |
Demographics | ||||
Age, mean (SD) | 53.8 (15.9) | 53.6 (16.7) | 1.00 (1.00 to 1.00) | 1.00 (1.00 to 1.00) |
Male sex, n (%) (REF=female) | 3341 (28.6) | 2328 (28.9) | 1.01 (0.95 to 1.07) | 1.04 (0.97 to 1.11) |
Income quintile, n(%) (REF=1—low) | 59 (0.5) | 50 (0.6) | REF | REF |
2 | 2197 (18.8) | 1693 (21) | 1.10 (1.00 to 1.20) | 1.08 (0.98 to 1.18) |
3 | 2359 (20.2) | 1657 (20.5) | 1.12 (1.03 to 1.23) | 1.11 (1.01 to 1.22) |
4 | 2407 (20.6) | 1627 (20.2) | 1.12 (1.02 to 1.23) | 1.09 (0.99 to 1.20) |
5 | 2305 (19.7) | 1581 (19.6) | 1.22 (1.11 to 1.34) | 1.18 (1.07 to 1.30) |
Calendar-year of cohort entry (REF=2000) | ||||
2000 | 1110 | 774 | REF | REF |
2001 | 1110 | 768 | 0.99 (0.87 to 1.13) | 0.99 (0.87 to 1.14) |
2002 | 1074 | 736 | 1.00 (0.87 to 1.14) | 1.00 (0.87 to 1.15) |
2003 | 1154 | 830 | 0.96 (0.85 to 1.10) | 0.99 (0.87 to 1.13) |
2004 | 1187 | 872 | 0.94 (0.83 to 1.08) | 0.99 (0.87 to 1.14) |
2005 | 1231 | 828 | 1.05 (0.92 to 1.20) | 1.12 (0.98 to 1.28) |
2006 | 1179 | 782 | 1.07 (0.94 to 1.22) | 1.13 (0.98 to 1.29) |
2007 | 1237 | 818 | 1.07 (0.94 to 1.23) | 1.14 (0.99 to 1.31) |
2008 | 1268 | 885 | 1.01 (0.89 to 1.16) | 1.10 (0.96 to 1.26) |
2009 | 1144 | 773 | 1.03 (0.90 to 1.18) | 1.10 (0.95 to 1.27) |
Comorbidity: number of Hopkins ADGs in the 2 years prior to entry, n (%) (REF=<5) | ||||
<5 | 3031 (25.9) | 2198 (27.3) | REF | REF |
5–9 | 5802 (49.6) | 3988 (49.4) | 1.04 (0.97 to 1.12) | 1.04 [0.97 to 1.12] |
10+ | 2861 (24.5) | 1880 (23.3) | 1.08 (0.99 to 1.18) | 1.07 [0.98 to 1.17] |
Hospitalisation for RA prior to rheumatologist visit/end of study period, n(%) | 71 (0.6) | 41 (0.5) | 1.24 (0.84 to 1.84) | 1.34 [0.89 to 2.02] |
Geographic | ||||
Patient rural residence, n(%); (REF=urban) | 1636 (14.0) | 1560 (19.3) | 0.70 (0.64 to 0.76) | 0.92 (0.83 to 1.01) |
Rheumatology supply per 100 000 adults, mean (SD) | 1.6 (1.1) | 1.4 (1.0) | 1.16 (1.12 to 1.19) | 1.35 (1.13 to 1.60) |
Distance to rheumatologist (km), mean (SD) | 17.8 (64.24) | 33.6 (75.89) | n/a | n/a |
Remote distance (≥100 km to rheumatologist), n(%) | 312 (2.7) | 735 (9.1) | 0.29 (0.25 to 0.34) | 0.51 (0.41 to 0.64) |
Primary care physician | ||||
Male sex, n (%) (REF=female) | 8069 (69.0) | 5803 (71.9) | 0.83 (0.77 to 0.89) | 0.87 (0.81 to 0.95) |
Years since graduation, mean (SD) | 24.3 (10.48) | 24.6 (10.53) | 1.00 (0.99 to 1.00) | 1.00 (0.99 to 1.00) |
Practice type†, n (%) (REF=fee-for-service) | ||||
Traditional and enhanced fee-for-service | 11 085 (94.8) | 7699 (95.5) | REF | REF |
Blended capitation models | 609 (5.2) | 367 (4.5) | 1.14 (0.98 to 1.32) | 1.15 (0.99 to 1.34) |
*Adjusted for all covariates including: patient demographics, clinical factors, primary care physician characteristics, provider continuity and geographic characteristics (including regional variation by regional health service planning areas LHINs not reported here).
†Practice types: blended capitation models (FHNs, FHOs, FHTs, an interprofessional team model composed of FHNs and FHOs), enhanced fee-for-service models (FHGs and other groups) and solo fee-for-service practitioners (those who did not belong to a model).
ADG, Adjusted Diagnostic Groups; FGH, Family Health Group; FHN, Family Health Network; FHO, Family Health Organisation; FHT, Family Health Team; LHIN, Local Health Integration Network; RA, rheumatoid arthritis.