Rural patients with osteoarthritis, rheumatoid arthritis less likely to use in-person care
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Key takeaways:
- Rural patients with RA or OA were less likely to report in-person physician visits and diagnostic tests than urban patients.
- Urban patients were more likely to visit rheumatologists but less likely to visit primary care physicians.
Patients with rheumatoid arthritis or osteoarthritis in rural areas are less likely to report in-person health care use, including physician visits and diagnostic tests, vs. those in urban areas, according to data.
“Rural residence has been associated with disparities in health care related outcomes in both rheumatic diseases and other chronic conditions in the United States,” Luke W. Desilet, DO, of the University of Nebraska Medical Center, in Omaha, and colleagues wrote in Arthritis Care & Research. “Studies have demonstrated that those with rheumatic disease in rural areas have more osteoarthritis (OA)-related disability, higher rates of surgical reconstruction for rheumatoid hand deformities, and lower rheumatoid arthritis (RA)-associated health-related quality of life.”
To investigate the potential relationship between urban and rural patients with RA or OA and reported health care use, Desilet and colleagues analyzed data found in FORWARD, a national database of patients with rheumatic diseases. All patients in the bank are volunteers with diagnoses confirmed by a physician. For this analysis, the researchers included patients diagnosed with RA or OA who had completed 6-month, semiannual surveys between 1999 and 2019.
The primary outcome was health care use based on various geographic categories — small or isolated rural areas, large rural areas and urban areas. Specific variables the researchers analyzed included any health care visit, any rheumatology visit, any visit with primary care physicians, visits with other types of clinicians, visits with non-physician or non-traditional providers, and diagnostic tests, as well as a combination measurement of all aforementioned variables.
The analysis included a total of 37,802 patients with RA and 8,248 patients with OA. Among those with RA, patients from urban areas reported more overall in-person health care use, including physician visits and diagnostic tests, compared with patients in small or isolated rural areas. Specifically, these patients reported more visits to rheumatologists than rural patients (IRR = 1.22; 95% CI, 1.18-1.27), but fewer visits to primary care doctors (IRR = 0.90; 95% CI, 0.85-0.94).
Among patients with OA, urban-rural disparities were less severe. However, those living in urban areas were still more likely to record higher levels of health care use.
“This study highlights the need to implement health care delivery techniques and incentives to broaden access to rheumatologic care in rural communities,” Desilet and colleagues wrote. “Additional research is needed to examine the specific patient and system-related factors that impair access to rheumatologic care in rural communities.”
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