A total of 7% of Medicare beneficiaries who visited a rheumatologist in 2009 traveled at least 3 hours round-trip to do so, according to a study published online in Seminars in Arthritis and Rheumatism.
“This study confirms that a small but significant proportion of patients in the [United States] have long travel times to visit a rheumatologist, and that the most important determinant of long travel times is supply of rheumatologists,” said Dr. Gabriela Schmajuk and her associates at the University of California, San Francisco. Access to care was especially limited in the Mountain region of the United States, the investigators said. “Assessing the best methods for attracting and retaining rheumatologists to low-supply areas and providing high-quality care to rural beneficiaries will be crucial challenges for policy makers and professional societies,” they added.
©Michael Shake/Fotolia.com
Despite recent rises in numbers of U.S. patients with arthritis and other rheumatic conditions, no prior study has reported national estimates for access to rheumatology care, the researchers noted.
They studied Medicare Part B insurance claims for 41,693 patients who visited a rheumatologist at least once in 2009. Data were from the Chronic Conditions Data Warehouse, a Medicare and Medicaid research database. The researchers used the amount of time patients traveled to see a rheumatologist as a proxy for access to care, and estimated travel times in Google Maps by calculating distances between the center of each beneficiary’s zip code and the center of the zip code of their rheumatologist’s office (Sem. Arthritis Rheum. 2015 Jul 28. doi: 10.1016/j.semarthrit.2015.07.007).
Medicare patients traveled a median of 22 minutes to see a rheumatologist in 2009 (interquartile range, 12-40 minutes), for a median one-way distance of 9.3 miles (interquartile range, 4-22 miles), and an average of 3.4 visits per patient (standard deviation, 2.8 visits), said the investigators. But nearly 3,000 (7%) patients traveled at least 90 minutes one way for their appointments, they reported. Rural areas of the country had substantially higher proportions of patients who faced long times for care, compared with urban areas, even after the investigators controlled for baseline differences among patients, they said. In particular, 17% of patients who lived in hospital service areas that lacked rheumatologists traveled at least 90 minutes one way, compared with 3%-4% of patients in areas with better access to care. “Although living in an area with a low supply of rheumatologists was a critical determinant of long travel times, other factors, including being male, white, and living in lower socioeconomic status areas were also important,” the investigators added.
Other studies that have examined driving distance to rheumatologists as a proxy for access to care have reported similar results for the impacts of gender and race (Arthritis Care Res. 2014;66[11]:1634-43) or socioeconomic status (Arthritis Care Res. 2015;67[2]:230-9), they noted.
The estimated number of rheumatologists came within 10% of the number listed in the 2010 membership directory for the American College of Rheumatology, but travel times might have been underestimated for lower-income patients because these individuals might have been more likely to travel by public transportation, the researchers noted. The study also did not account for patients who received rheumatology care from general providers, the authors said.