Liu Xiaoxiao, Patel Alka B, Seidel Judy E, Mosher Dianne P, Hagens John, Marshall Deborah A
Department of Community Health Science, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
McCaig Bone and Joint Health Institute, University of Calgary, Calgary, AB, Canada.
Int J Equity Health. 2025 Mar 27;24(1):84. doi: 10.1186/s12939-025-02439-w.
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.
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.
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.
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.
在加拿大，实现医疗服务可及性的公平是国家和省级层面的优先事项，以解决健康差距问题。然而，由于广大农村地区类风湿关节炎（RA）患病率显著更高，而RA护理提供者主要集中在两个最大城市，公平可及性仍然是一项挑战。城乡在可及性方面的差距可能部分归因于地理障碍。衡量RA患者的就医出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为实现公平的医疗服务提供信息非常重要。
于2019年4月1日至2020年3月31日期间对加拿大艾伯塔省的RA患者进行了一项横断面研究。基于行政健康数据，使用经过验证的RA病例定义确定RA队列。使用网络分析计算患者邮政编码与提供者诊所邮政编码之间的出行时间。在地理区域层面报告出行时间中位数。应用Wilcoxon秩和检验来检验城乡类别之间的统计显著性。使用反向累积概率方法对出行时间对医疗服务利用的距离衰减效应进行建模。
RA患者看全科医生（GP）的出行时间中位数为13分钟（四分位间距：5 - 28分钟），看风湿病专家的出行时间中位数为34分钟（四分位间距：21 - 51分钟）。在获得GP和风湿病护理方面存在显著的城乡差距。结果显示，在整个城乡连续体中，看GP的出行时间相差4倍（偏远地区：5分钟，四分位间距5 - 79分钟；中等规模城市：20分钟，四分位间距7 - 34分钟），看风湿病专家的出行时间相差8.7倍（偏远地区：226分钟，四分位间距165 - 331分钟；城市：26分钟，四分位间距17 - 36分钟）。偏远地区的患者看风湿病护理的出行时间最长，但看GP护理的出行时间中位数最短。在偏远地区，与其他城乡连续体相比，出行时间对医疗服务利用的影响最弱。
衡量RA患者就医的出行负担揭示了患者根据居住地理位置寻求RA护理的出行距离差异模式。这些发现将为医疗规划提供证据，并解决观察到的差距，以实现公平医疗的目标。
