From Sunnybrook Research Institute, Holland Bone and Joint Program; University of Toronto, Institute of Health Policy, Management and Evaluation; ICES; Arthritis Research Canada; Women's College Research Institute; Sinai Health System, University of Toronto, Toronto, Ontario; McGill University, Department of Epidemiology; Research Institute of the McGill University Health Centre, Montreal, Quebec; William Osler Health System, Brampton, Ontario; The Cumming School of Medicine, University of Calgary, Calgary, Alberta; McMaster University, Department of Family Medicine, Hamilton; Western University, Schulich School of Medicine & Dentistry; St. Joseph's Health Care London, London, Ontario; Southlake Regional Health Centre, Newmarket, Ontario, Canada.
J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Program, and University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, and Research Institute of the McGill University Health Centre; J.E. Pope, MD, FRCPC, MPH, Western University, Schulich School of Medicine & Dentistry, and St. Joseph's Health Care London; V. Ahluwalia, MD, FRCPC, William Osler Health System; C.E. Barber, MD, FRCPC, PhD, The Cumming School of Medicine, University of Calgary, and Arthritis Research Canada; L. Eder, MD, PhD, University of Toronto, Institute of Health Policy, Management and Evaluation, and Women's College Research Institute; B. Kuriya, MD, FRCPC, SM, Sinai Health System, University of Toronto; V. Ling, MSc, ICES; J.M. Paterson, MSc, University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES, and McMaster University, Department of Family Medicine; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre.
J Rheumatol. 2020 Mar;47(3):468-476. doi: 10.3899/jrheum.190034. Epub 2019 Jun 15.
To quantify population-level and practice-level encounters with rheumatologists over time.
We conducted a population-based study from 2000 to 2015 in Ontario, Canada, where all residents are covered by a single-payer healthcare system. Annual total number of unique patients seen by rheumatologists, the number of new patients seen, and total number of encounters with rheumatologists were identified.
From 2000 to 2015, the percentage of the population seen by rheumatologists was constant over time (2.7%). During this time, Ontario had a stable supply of rheumatologists (0.8 full-time equivalents/75,000). From 2000 to 2015, the number of annual rheumatology encounters increased from 561,452 to 786,061, but the adjusted encounter rates remained stable over time (at 62 encounters per 1000 population). New patient assessment rates declined over time from 10 new outpatient assessments per 1000 in 2000 to 6 per 1000 in 2015. The crude volume of new patients seen annually decreased and an increasing proportion of rheumatology encounters were with established patients. We observed a shift in patient case mix over time, with more assessments for systemic inflammatory conditions. Rheumatologists' practice volumes, practice sizes, and the annual number of days providing clinical care decreased over time.
Over a 15-year period, the annual percentage of the population seen by a rheumatologist remained constant and the volume of new patients decreased, while followup patient encounters increased. Patient encounters per rheumatologist decreased over time. Our findings provide novel information for rheumatology workforce planning. Factors affecting clinical activity warrant further research.
随着时间的推移，量化人群水平和实践水平上与风湿病医生的接触。
我们在加拿大安大略省进行了一项基于人群的研究，时间跨度为 2000 年至 2015 年，所有居民都享有单一支付者的医疗保健系统。确定了风湿病医生每年接诊的独特患者总数、新患者接诊数和与风湿病医生的总接触数。
从 2000 年到 2015 年，接受风湿病医生治疗的人群比例保持不变（2.7%）。在此期间，安大略省的风湿病医生数量稳定（每 75000 人中有 0.8 个全职当量）。从 2000 年到 2015 年，每年的风湿病就诊次数从 561452 次增加到 786061 次，但调整后的就诊率随着时间的推移保持稳定（每 1000 人 62 次）。新患者评估率随时间下降，从 2000 年的每 1000 人中有 10 次新的门诊评估降至 2015 年的 6 次。每年新患者就诊量减少，越来越多的风湿病就诊是针对已建立的患者。我们观察到患者病例组合随时间发生变化，评估系统性炎症性疾病的次数增加。风湿病医生的实践量、实践规模以及提供临床护理的年天数随着时间的推移而减少。
在 15 年期间，接受风湿病医生治疗的人群比例保持不变，新患者就诊量减少，而随访患者就诊量增加。每位风湿病医生的就诊量随时间减少。我们的研究结果为风湿病劳动力规划提供了新的信息。影响临床活动的因素需要进一步研究。
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