Resumen
Background and aims: Canada’s large geographic area and low population density pose challenges in access to specialized health care for remote and rural residents. We compared health services use, surgical rate, and specialist gastroenterologist care in rural and urban inflammatory bowel disease (IBD) patients in Canada. Methods: We used validated algorithms that were applied to population-based health administrative data to identify all people living with the following three Canadian provinces: Alberta, Manitoba, and Ontario (ON). We compared rural residents with urban residents for time to diagnosis, hospitalizations, outpatient visits, emergency department (ED) use, surgical rate, and gastroenterologist care. Multivariable regression compared the outcomes in rural/urban patients, controlling for confounders. Provincial results were meta-analyzed using random-effects models to produce overall estimates. Results: A total of 36,656 urban and 5,223 rural residents with incident IBD were included. Outpatient physician visit rate was similar in rural and urban patients. IBD-specific and IBD-related hospitalization rates were higher in rural patients (incidence rate ratio [IRR] 1.17, 95% CI 1.02–1.34, and IRR 1.27, 95% CI 1.04–1.56, respectively). The rate of ED visits in ON were similarly elevated for rural patients (IRR 1.53, 95% CI 1.42–1.65, and IRR 1.33, 95% CI 1.25–1.40). There were no differences in surgical rates or prediagnosis lag time between rural and urban patients. Rural patients had fewer IBD-specific gastroenterologist visits (IRR 0.79, 95% CI 0.73–0.84) and a smaller proportion of their IBD-specific care was provided by gastro-enterologists (28.3% vs 55.2%, P<0.0001). This was less pronounced in children <10 years at diagnosis (59.3% vs 65.0%, P<0.0001), and the gap was widest in patients >65 years (33.0% vs 59.2%, P<0.0001). Conclusion: There were lower rates of gastroenterologist physician visits, more hospitalizations, and greater rates of ED visits in rural IBD patients. These disparities in health services use result in costlier care for rural patients. Innovative methods of delivering gastroenterology care to rural IBD patients (such as telehealth, online support, and remote clinics) should be explored, especially for communities lacking easy access to gastroenterologists.
| Idioma original | English |
|---|---|
| Páginas (desde-hasta) | 1613-1626 |
| Número de páginas | 14 |
| Publicación | Clinical Epidemiology |
| Volumen | 10 |
| DOI | |
| Estado | Published - 2018 |
Nota bibliográfica
Funding Information:corrected since publication of these abstracts. The authors would like to thank Danielle Birman and Shabnaz Siddiq who acted as research coordinators for CanGIEC. This research was funded by an unrestricted, peer-reviewed operating grant from the Janssen Future Leaders in IBD Program and a Foundation Grant from the Canadian Institutes of Health Research (CIHR). This study is based in part on data provided by Alberta Health and Manitoba Health. The interpretation and conclusions contained herein are those of the researchers and do not necessarily represent the views of the Governments of Alberta and Manitoba. Neither the Government of Alberta nor Alberta Health expressed any opinion in relation to this study. This study was supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results, and conclusions reported in this article are those of the authors and are independent from the funding sources. No endorsement by ICES or the ON MOHLTC is intended or should be inferred.
Funding Information:
Eric I Benchimol and Geoffrey C Nguyen were supported by New Investigator Awards from CIHR, Crohn’s and Colitis Canada, and the Canadian Association of Gastroenterology. Eric I Benchimol was also supported by the Career Enhancement Program from the Canadian Child Health Clinician Scientist Program. M Ellen Kuenzig was supported by a PostDoctoral Fellowship Award from CIHR, Crohn’s and Colitis Canada, and the Canadian Association of Gastroenterology. Charles N Bernstein was supported in part by the Bingham Chair in Gastroenterology. Geoffrey C Nguyen and Gilaad G Kaplan were CIHR Embedded Clinician Research Chairs. Astrid Guttmann was supported by a CIHR Applied Chair in Reproductive and Child Health Services and Policy Research. Lisa M Lix was supported by a Canada Research Chair (Tier I). The authors report no other conflicts of interest in this work.
Publisher Copyright:
© 2018 Benchimol et al.
ASJC Scopus Subject Areas
- Epidemiology