Factors associated with access to rheumatologists for Medicare patients

Abstract

Objective Despite looming rheumatologist shortages and a growing number of patients with arthritis and other rheumatic conditions, nationwide estimates of access to rheumatology care have never been reported. We aimed to measure travel times as a proxy to access to care and to determine the individual and area-level factors associated with long travel times to rheumatologists in the U.S. Methods We used Medicare Part B claims for the 2009 Medicare Chronic Condition Warehouse 5% rheumatoid arthritis/osteoarthritis cohort. Using Google Maps we estimated driving time from the center of a beneficiary’s home ZIP code to the center of their rheumatologist’s office ZIP code. We examined predictors of travel time ≥ 90 minutes in a series of generalized linear mixed models adjusting for rheumatologist supply, rurality, and individual patient characteristics including age, race, gender, and income. Results We included 41,693 Medicare beneficiaries with one or more visits to a rheumatologist in 2009. The median estimated beneficiary travel time to a rheumatologist was 22 minutes (interquartile range (IQR) 12–40 minutes). Seven percent of beneficiaries travelled 90 minutes or longer to visit a rheumatologist. Even after adjusting for covariates, independent predictors of long travel times included living in areas with no or low supply of rheumatologists and living in the Mountain region of the U.S. Conclusions A small but significant proportion of patients in the U.S. travelled very long distances to visit a rheumatologist, and most of these individuals resided in areas with no or low supplies of rheumatologists. These data suggest that addressing shortages in rheumatology care for patients in low-supply areas is a key target for improving access to rheumatologists.

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Area of Residence and Socioeconomic Factors Reduce Access to Biologics for Rheumatoid Arthritis Patients in Romania

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