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The pathway to orthopaedic surgery: a population study of the role of access to primary care and availability of orthopaedic services in Ontario, Canada.

Canizares M, Davis AM, Badley EM - BMJ Open (2014)

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: The Arthritis Community Research and Evaluation Unit, Division of Health Care and Outcomes Research, Toronto Western Research Institute, Toronto, Ontario, Canada Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada.

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Conceptual model (A) and summary of findings (B), combining the results of main effect and adjusted models. RR, rate ratio; RR are for highest quintile versus lowest quintile of the distribution; NS, not significant. All estimates are adjusted for age, sex age and sex interaction, area-level socioeconomic status, proportion population 65 years and over and proportion of rural population.
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BMJOPEN2013004472F1: Conceptual model (A) and summary of findings (B), combining the results of main effect and adjusted models. RR, rate ratio; RR are for highest quintile versus lowest quintile of the distribution; NS, not significant. All estimates are adjusted for age, sex age and sex interaction, area-level socioeconomic status, proportion population 65 years and over and proportion of rural population.

Mentions: Our analytic strategy is presented in figure 1A. In summary, we expect that, in a referral system, access to PCPs as well as the geographic availability of orthopaedic surgeons will be associated with the rates of office visits to orthopaedic surgeons. Furthermore, studies suggest that proximity to specialists influence PCPs referral decisions.2930 We therefore, expect that the relationship between access to PCPs and the rate of orthopaedic surgeons office visits will be modified by the geographic availability of orthopaedic surgeons. Finally, we anticipate that access to PCPs, the geographic availability of orthopaedic surgeons, and office visits to orthopaedic surgeons will be positively associated with orthopaedic surgery rates.


The pathway to orthopaedic surgery: a population study of the role of access to primary care and availability of orthopaedic services in Ontario, Canada.

Canizares M, Davis AM, Badley EM - BMJ Open (2014)

Conceptual model (A) and summary of findings (B), combining the results of main effect and adjusted models. RR, rate ratio; RR are for highest quintile versus lowest quintile of the distribution; NS, not significant. All estimates are adjusted for age, sex age and sex interaction, area-level socioeconomic status, proportion population 65 years and over and proportion of rural population.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4120425&req=5

BMJOPEN2013004472F1: Conceptual model (A) and summary of findings (B), combining the results of main effect and adjusted models. RR, rate ratio; RR are for highest quintile versus lowest quintile of the distribution; NS, not significant. All estimates are adjusted for age, sex age and sex interaction, area-level socioeconomic status, proportion population 65 years and over and proportion of rural population.
Mentions: Our analytic strategy is presented in figure 1A. In summary, we expect that, in a referral system, access to PCPs as well as the geographic availability of orthopaedic surgeons will be associated with the rates of office visits to orthopaedic surgeons. Furthermore, studies suggest that proximity to specialists influence PCPs referral decisions.2930 We therefore, expect that the relationship between access to PCPs and the rate of orthopaedic surgeons office visits will be modified by the geographic availability of orthopaedic surgeons. Finally, we anticipate that access to PCPs, the geographic availability of orthopaedic surgeons, and office visits to orthopaedic surgeons will be positively associated with orthopaedic surgery rates.

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: The Arthritis Community Research and Evaluation Unit, Division of Health Care and Outcomes Research, Toronto Western Research Institute, Toronto, Ontario, Canada Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada.

Show MeSH
Related in: MedlinePlus