Informing equitable access to care: a cross-sectional study of travel burden to primary and rheumatology care for people with rheumatoid arthritis
Abstract Background Achieving equity in access to care is a priority at both national and provincial levels in Canada to address health disparities. However, equitable access remains a challenge due to significantly higher rheumatoid arthritis (RA) prevalence in vast rural areas, whereas the RA care...
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BMC
2025-03-01
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| Series: | International Journal for Equity in Health |
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| Online Access: | https://doi.org/10.1186/s12939-025-02439-w |
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| author | Xiaoxiao Liu Alka B Patel Judy E Seidel Dianne P. Mosher John Hagens Deborah A Marshall |
| author_facet | Xiaoxiao Liu Alka B Patel Judy E Seidel Dianne P. Mosher John Hagens Deborah A Marshall |
| author_sort | Xiaoxiao Liu |
| collection | DOAJ |
| description | Abstract Background Achieving equity in access to care is a priority at both national and provincial levels in Canada to address health disparities. However, equitable access remains a challenge due to significantly higher rheumatoid arthritis (RA) prevalence in vast rural areas, whereas the RA care providers are primarily concentrated in the two largest cities. Rural-urban disparities in access may be partially attributed to geographic barriers. It is important to measure travel burden of people with RA for developing targeted interventions and policies to mitigate identified geographic barriers and informing equitable access to health care. Methods A cross-sectional study was conducted between April 1, 2019 and March 31, 2020 for people with RA in Alberta, Canada. RA cohort was identified using a validated RA case definition based on administrative health data. Travel time between patients’ postal codes and providers’ clinic postal codes was calculated using network analysis. Median travel time was reported at geographic area level. Wilcoxon Rank Sum Test was applied to test the statistical significance between rural-urban categories. The distance decay effect of travel time on health care utilizaton was modelled using a reverse cumulative probability approach. Results RA patients took a median of 13 min (IQR: 5–28) to visit general practitioners (GPs) and 34 min (IQR: 21–51) to visit rheumatologists. There were significant rural-urban disparities in access to GP and rheumatology care. The results showed a 4-fold difference in GP travel time (remote areas:5 min, IQR 5–79; moderate metro:20 min, IQR 7–34) and 8.7-fold difference to rheumatologist visit (remote: 226 min, IQR 165–331; metro: 26 min, IQR 17–36) across the rural-urban continuum. Remote patients experienced the longest travel time to rheumatology care but the shortest median travel time to GP care. In remote areas, travel time showed the weakest impact on health care utilization compared to other rural-urban continuum. Conclusions Measuring the travel burden for people with RA to access care reveals patterns about the differences in how far patients travelled to seek RA care based on their residential geographic location. These findings will provide evidence to inform health care planning and address observed disparities towards the goal of achieving equitable care. |
| format | Article |
| id | doaj-art-5713f1dee448448daaa31abac9782cb7 |
| institution | DOAJ |
| issn | 1475-9276 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal for Equity in Health |
| spelling | doaj-art-5713f1dee448448daaa31abac9782cb72025-08-20T02:49:31ZengBMCInternational Journal for Equity in Health1475-92762025-03-0124111410.1186/s12939-025-02439-wInforming equitable access to care: a cross-sectional study of travel burden to primary and rheumatology care for people with rheumatoid arthritisXiaoxiao Liu0Alka B Patel1Judy E Seidel2Dianne P. Mosher3John Hagens4Deborah A Marshall5Department of Community Health Science, Cumming School of Medicine, University of CalgaryDepartment of Community Health Science, Cumming School of Medicine, University of CalgaryDepartment of Community Health Science, Cumming School of Medicine, University of CalgaryDepartment of Medicine, University of CalgaryDepartment of Community Health Science, Cumming School of Medicine, University of CalgaryDepartment of Community Health Science, Cumming School of Medicine, University of CalgaryAbstract Background Achieving equity in access to care is a priority at both national and provincial levels in Canada to address health disparities. However, equitable access remains a challenge due to significantly higher rheumatoid arthritis (RA) prevalence in vast rural areas, whereas the RA care providers are primarily concentrated in the two largest cities. Rural-urban disparities in access may be partially attributed to geographic barriers. It is important to measure travel burden of people with RA for developing targeted interventions and policies to mitigate identified geographic barriers and informing equitable access to health care. Methods A cross-sectional study was conducted between April 1, 2019 and March 31, 2020 for people with RA in Alberta, Canada. RA cohort was identified using a validated RA case definition based on administrative health data. Travel time between patients’ postal codes and providers’ clinic postal codes was calculated using network analysis. Median travel time was reported at geographic area level. Wilcoxon Rank Sum Test was applied to test the statistical significance between rural-urban categories. The distance decay effect of travel time on health care utilizaton was modelled using a reverse cumulative probability approach. Results RA patients took a median of 13 min (IQR: 5–28) to visit general practitioners (GPs) and 34 min (IQR: 21–51) to visit rheumatologists. There were significant rural-urban disparities in access to GP and rheumatology care. The results showed a 4-fold difference in GP travel time (remote areas:5 min, IQR 5–79; moderate metro:20 min, IQR 7–34) and 8.7-fold difference to rheumatologist visit (remote: 226 min, IQR 165–331; metro: 26 min, IQR 17–36) across the rural-urban continuum. Remote patients experienced the longest travel time to rheumatology care but the shortest median travel time to GP care. In remote areas, travel time showed the weakest impact on health care utilization compared to other rural-urban continuum. Conclusions Measuring the travel burden for people with RA to access care reveals patterns about the differences in how far patients travelled to seek RA care based on their residential geographic location. These findings will provide evidence to inform health care planning and address observed disparities towards the goal of achieving equitable care.https://doi.org/10.1186/s12939-025-02439-wRheumatoid arthritisPrimary careRheumatology careEquitable accessTravel timeRural-urban disparities |
| spellingShingle | Xiaoxiao Liu Alka B Patel Judy E Seidel Dianne P. Mosher John Hagens Deborah A Marshall Informing equitable access to care: a cross-sectional study of travel burden to primary and rheumatology care for people with rheumatoid arthritis International Journal for Equity in Health Rheumatoid arthritis Primary care Rheumatology care Equitable access Travel time Rural-urban disparities |
| title | Informing equitable access to care: a cross-sectional study of travel burden to primary and rheumatology care for people with rheumatoid arthritis |
| title_full | Informing equitable access to care: a cross-sectional study of travel burden to primary and rheumatology care for people with rheumatoid arthritis |
| title_fullStr | Informing equitable access to care: a cross-sectional study of travel burden to primary and rheumatology care for people with rheumatoid arthritis |
| title_full_unstemmed | Informing equitable access to care: a cross-sectional study of travel burden to primary and rheumatology care for people with rheumatoid arthritis |
| title_short | Informing equitable access to care: a cross-sectional study of travel burden to primary and rheumatology care for people with rheumatoid arthritis |
| title_sort | informing equitable access to care a cross sectional study of travel burden to primary and rheumatology care for people with rheumatoid arthritis |
| topic | Rheumatoid arthritis Primary care Rheumatology care Equitable access Travel time Rural-urban disparities |
| url | https://doi.org/10.1186/s12939-025-02439-w |
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