Mayilee Canizares

Health care utilization for musculoskeletal disorders

To examine patterns of ambulatory care and hospital utilization for people with musculoskeletal disorders (MSDs), including arthritis and related conditions, bone and spinal conditions, trauma and related conditions, and unspecified MSDs.

Association of regional racial/cultural context and socioeconomic status with arthritis in the population: A multilevel analysis

OBJECTIVE To examine the extent to which differences in individual- and regional-level socioeconomic status and racial/cultural origin account for geographic variations in the prevalence of self-reported arthritis, and to determine whether regional characteristics modify the effect of individual characteristics associated with reporting arthritis. METHODS Analyses were based on the 2000-2001 Canadian Community Health Survey (>15 years, n = 127,513). Arthritis was self-reported as a long-term condition diagnosed by a health professional. A 2-level logistic regression model was used to identify predictors of reporting arthritis. Individual-level variables included age, sex, income, education, immigration status, racial/cultural origin, smoking, physical activity, and body mass index. Regional-level variables included the proportion of low-income families, low education, unemployment, recent immigrants, Aboriginals, and Asians. RESULTS At the individual level, age, sex, low income, low education, Aboriginal origin, current smoking, and overweight/obesity were positively associated with reporting arthritis; recent immigration and Asian origin were negatively associated with reporting arthritis. At the regional level, percentages of low-income families and the Aboriginal population were independently associated with reporting arthritis. Regional income and racial/cultural origin moderated the effects of individual income and racial/cultural origin; low-income individuals residing in regions with a higher proportion of low-income families reported arthritis more than low-income individuals living in better-income regions. CONCLUSION Both individual and regional factors were found to contribute to variations in the prevalence of arthritis, although significant unexplained variation remained. Further research is required to better understand the mechanisms that underlie these regional effects and to identify other contributing factors to the remaining variation.

Magnitude of impact and healthcare use for musculoskeletal disorders in the paediaric: a population-based study

BackgroundAlthough musculoskeletal disorders (MSD) are among the most prevalent chronic conditions, minimal attention has been paid to the paediatric population. The aim of this study is to describe the annual prevalence of healthcare contacts for MSD by children and youth age 0-19 years, including type of MSD, care delivery setting and the specialty of the physician consulted.MethodsAnalysis of data on all children with healthcare contacts for MSD in Ontario, Canada using data from universal health insurance databases on ambulatory physician and emergency department (ED) visits, same-day outpatient surgery, and in-patient admissions for the fiscal year 2006/07. The proportion of children and youth seeing different physician specialties was calculated for each physician and condition grouping. Census data for the 2006 Ontario population was used to calculate person visit rates.Results122.1 per 1,000 children and youth made visits for MSD. The majority visited for injury and related conditions (63.2 per 1,000), followed by unspecified MSD complaints (33.0 per 1,000), arthritis and related conditions (27.7 per 1,000), bone and spinal conditions (14.2 per 1,000), and congenital anomalies (3 per 1,000). Injury was the most common reason for ED visits and in-patient admissions, and arthritis and related conditions for day-surgery. The majority of children presented to primary care physicians (74.4%), surgeons (22.3%), and paediatricians (10.1%). Paediatricians were more likely to see younger children and those with congenital anomalies or arthritis and related conditions.ConclusionOne in eight children and youth make physician visits for MSD in a year, suggesting that the prevalence of MSD in children may have been previously underestimated. Although most children may have self-limiting conditions, it is unknown to what extent these may deter involvement in physical activity, or be indicators of serious and potentially life-threatening conditions. Given deficiencies in medical education, particularly of primary care physicians and paediatricians, it is important that training programs devote an appropriate amount of time to paediatric MSD.

A population-based study of ambulatory and surgical services provided by orthopaedic surgeons for musculoskeletal conditions

BackgroundThe ongoing process of population aging is associated with an increase in prevalence of musculoskeletal conditions with a concomitant increase in the demand of orthopaedic services. Shortages of orthopaedic services have been documented in Canada and elsewhere. This population-based study describes the number of patients seen by orthopaedic surgeons in office and hospital settings to set the scene for the development of strategies that could maximize the availability of orthopaedic resources.MethodsAdministrative data from the Ontario Health Insurance Plan and Canadian Institute for Health Information hospital separation databases for the 2005/06 fiscal year were used to identify individuals accessing orthopaedic services in Ontario, Canada. The number of patients with encounters with orthopaedic surgeons, the number of encounters and the number of surgeries carried out by orthopaedic surgeons were estimated according to condition groups, service location, patients age and sex.ResultsIn 2005/06, over 520,000 Ontarians (41 per 1,000 population) had over 1.3 million encounters with orthopaedic surgeons. Of those 86% were ambulatory encounters and 14% were in hospital encounters. The majority of ambulatory encounters were for an injury or related condition (44%) followed by arthritis and related conditions (37%). Osteoarthritis accounted for 16% of all ambulatory encounters. Orthopaedic surgeons carried out over 140,000 surgeries in 2005/06: joint replacement accounted for 25% of all orthopaedic surgeries, whereas closed repair accounted for 16% and reductions accounted for 21%. Half of the orthopaedic surgeries were for arthritis and related conditions.ConclusionThe large volume of ambulatory care points to the significant contribution of orthopaedic surgeons to the medical management of chronic musculoskeletal conditions including arthritis and injuries. The findings highlight that surgery is only one component of the work of orthopaedic surgeons in the management of these conditions. Policy makers and orthopaedic surgeons need to be creative in developing strategies to accommodate the growing workload of orthopaedic surgeons without sacrificing quality of care of patients with musculoskeletal conditions.

Benefits Gained, Benefits Lost: Comparing Baby Boomers to Other Generations in a Longitudinal Cohort Study of Self-Rated Health

UNLABELLED POLICY POINTS: Despite beliefs that baby boomers are healthier than previous generations, we found no evidence that the health of baby boomers is substantially different from that of the previous or succeeding cohorts. The effects of increased education, higher income, and lower smoking rates on improving self-rated health were nearly counterbalanced by the adverse effect of increasing body mass index (BMI). Assumptions that baby boomers will require less health care as they age because of better education, more prosperity, and less propensity to smoke may not be realized because of increases in obesity. CONTEXT Baby boomers are commonly believed to be healthier than the previous generation. Using self-rated health (SRH) as an indicator of health status, this study examines the effects of age, period, and birth cohort on the trajectory of health across 4 generations: World War II (born between 1935 and 1944), older baby boomers (born between 1945 and 1954), younger baby boomers (born between 1955 and 1964), and Generation X (born between 1965 and 1974). METHODS We analyzed Canadas longitudinal National Population Health Survey 1994-2010 (n = 8,570 at baseline), using multilevel growth models to estimate the age trajectory of SRH by cohort, accounting for period and incorporating the influence of changes in education, household income, smoking status, and body mass index (BMI) on SRH over time. FINDINGS SRH worsened with increasing age in all cohorts. Cohort differences in SRH were modest (p = 0.034), but there was a significant period effect (p = 0.002). We found marked cohort effects for increasing education, income, and BMI, and decreasing smoking from the youngest to the oldest cohorts, which were much reduced (education and smoking) or removed (income and BMI) once period was taken into account. At the population level, multivariable analysis showed the benefits of increasing education and income and declines in smoking on the trajectory of improving SRH were almost counterbalanced by the effects of increasing BMI (obesity). CONCLUSIONS We found no evidence to support the expectation that baby boomers will age more or less healthily than previous cohorts did. We also found that increasing BMI has likely undermined improvements in health that might have otherwise occurred, with possible implications for the need for health care. Period effects had a more profound effect than birth cohort effects. This suggests that interventions to improve health, such as reducing obesity, can be targeted to the entire, or a major portion of the, population and need not single out particular birth cohorts.

Visits to rheumatologists for arthritis: the role of access to primary care physicians, geographic availability of rheumatologists, and socioeconomic status.

This multilevel study examines access to rheumatologists for all arthritis and inflammatory arthritis, taking into account geographic availability of rheumatologists, access to primary care physicians (PCPs), and population characteristics (e.g., socioeconomic status [SES]).

Provision of Orthopaedic Workforce and Implications for Access to Orthopaedic Services in Ontario

BACKGROUND The aging population and increasing obesity rates will increase the prevalence of musculoskeletal conditions. Reports of orthopaedic surgeon shortages raise concerns about the ability of the health-care system to meet current and future demand in orthopaedics. A survey of all orthopaedic surgeons in Ontario, Canada, was carried out in 2006 to (1) update provision estimates of orthopaedic surgeons; (2) examine practice characteristics and perceived barriers to service; and (3) relate geographic availability of surgeons to population utilization of office-based and surgical orthopaedic services. METHODS A two-part questionnaire was sent to all orthopaedic surgeons in Ontario in 2006. Provision data in hours per week and full-time equivalents and practice patterns were analyzed by health region. Population-based data on the use of orthopaedic services were obtained from health service administrative databases. RESULTS There were 396 practicing orthopaedic surgeons in Ontario in 2006, equivalent to 2.43 full-time equivalents per 100,000 population, a finding similar to surveys in 1997 and 2000. Most surgeons were male, with a mean age of forty-nine years, with mainly adult practices; 48% reported having a subspecialty. Provision varied across Ontario, with an average of 112 hours per week of direct clinical time per 100,000 population (50% in the office, 30% in the operating room, 20% working on call). Many surgeons also reported time for administration, teaching, and research. Most respondents reported barriers to timely surgery, notably a lack of resources (operating room time, anesthesia, nursing, and/or bed capacity). Low orthopaedic provision was associated with lower utilization of office-based and surgical services, after controlling for neighborhood income and type of residence (urban or rural). CONCLUSIONS Shortages and geographic variation in the supply of surgeons mean that access to care continues to be a challenge in Ontario. In regions with fewer surgeons, residents are more likely to be deprived of office-based services, potentially affecting access to surgery and to orthopaedic expertise. In light of a potential shortage of surgeons, alternative methods of service provision may be needed to respond to the aging of the baby boomer population and an anticipated growth in the demand for surgery.

Self-management strategies in overweight and obese Canadians with arthritis.

To estimate the prevalence of overweight and obese Canadians with arthritis and to describe their use of arthritis self‐management strategies, as well as explore the factors associated with not engaging in any self‐management strategies.

Exercise/physical activity and weight management efforts in Canadians with self-reported arthritis.

To describe the exercise/physical activity and weight management efforts of Canadians with self‐reported arthritis, to examine factors associated with their engagement in these strategies to help manage their arthritis, and to explore reasons for lack of engagement.

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

Objective To examine the impact of access to primary care physicians (PCPs), geographic availability of orthopaedic surgeons, socioeconomic status (SES), proportion of older population (≥65 years) and proportion of rural population on orthopaedic surgeon office visits and orthopaedic surgery. Design Population multilevel study. Setting Ontario, Canada. Participants Ontario residents 18 years or older who had visits to orthopaedic surgeons or an orthopaedic surgery for musculoskeletal disorders in 2007/2008. Primary and secondary outcomes Office visits to orthopaedic surgeons and orthopaedic surgery. Results 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. After controlling for office visits with orthopaedic surgeons, the index of geographic availability of orthopaedic surgeons was no longer significantly associated with orthopaedic surgery. Conclusions 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. Efforts to address adequate access to orthopaedic surgery should also include improving and facilitating access to PCPs for referral, particularly in geographic areas with low orthopaedic surgeon availability.