Rural-Urban Disparities in Realized Spatial Access to General Practitioners, Orthopedic Surgeons, and Physiotherapists among People with Osteoarthritis in Alberta, Canada

Int J Environ Res Public Health. 2022 Jun 23;19(13):7706. doi: 10.3390/ijerph19137706.

Abstract

Rural Canadians have high health care needs due to high prevalence of osteoarthritis (OA) but lack access to care. Examining realized access to three types of providers (general practitioners (GPs), orthopedic surgeons (Ortho), and physiotherapists (PTs)) simultaneously helps identify gaps in access to needed OA care, inform accessibility assessment, and support health care resource allocation. Travel time from a patient's postal code to the physician's postal code was calculated using origin-destination network analysis. We applied descriptive statistics to summarize differences in travel time, hotspot analysis to explore geospatial patterns, and distance decay function to examine the travel pattern of health care utilization by urbanicity. The median travel time in Alberta was 11.6 min (IQR = 4.3-25.7) to GPs, 28.9 (IQR = 14.8-65.0) to Ortho, and 33.7 (IQR = 23.1-47.3) to PTs. We observed significant rural-urban disparities in realized access to GPs (2.9 and IQR = 0.0-92.1 in rural remote areas vs. 12.6 and IQR = 6.4-21.0 in metropolitan areas), Ortho (233.3 and IQR = 171.3-363.7 in rural remote areas vs. 21.3 and IQR = 14.0-29.3 in metropolitan areas), and PTs (62.4 and IQR = 0.0-232.1 in rural remote areas vs. 32.1 and IQR = 25.2-39.9 in metropolitan areas). We identified hotspots of realized access to all three types of providers in rural remote areas, where patients with OA tend to travel longer for health care. This study may provide insight on the choice of catchment size and the distance decay pattern of health care utilization for further studies on spatial accessibility.

Keywords: distance decay; general practitioners; orthopedic surgeons; osteoarthritis; physiotherapists; realized access; rural–urban; travel time.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Alberta / epidemiology
  • General Practitioners*
  • Health Services Accessibility
  • Humans
  • Orthopedic Surgeons*
  • Osteoarthritis* / epidemiology
  • Osteoarthritis* / therapy
  • Physical Therapists*
  • Rural Population

Grants and funding

This research was funded through the Arthur J.E. Child Chair in Rheumatology Research. D.M. was supported by the Arthur J.E. Child Chair in Rheumatology Research and a Canada Research Chair, Health Systems and Services Research (2008-18). X.L. was supported by the Arthur J.E. Child Chair in Rheumatology Research, the Cumming School of Medicine Postdoctoral Scholarship, and the Postdoctoral Scholarship funded by the O’Brien Institute of Public Health and the McCaig Institute for Bone and Joint Health.