Arthritis health service utilization among the elderly: the role of urban-rural residence and other utilization factors

Abstract

Objective: To compare the impact of urban-rural residence and other factors on the utilization of any type of arthritis-related physician care and on rheumatologist utilization.

Methods: A population-based random sample of adults 65 years of age or older with self-reported arthritis from 10 urban and 12 rural Iowa counties were surveyed by telephone interview. We estimated the arthritis prevalence and health service utilization in this sample and evaluated the effects of predisposing, enabling, and need factors on utilization and satisfaction. Health care utilization was defined as ever having visited specific types of providers for arthritis-related care.

Results: A total of 488 individuals participated: 227 from urban counties and 261 rural respondents. Urban respondents more commonly reported having received a diagnosis of osteoarthritis from their physicians but were less likely to report rheumatoid arthritis. A greater proportion of urban versus rural respondents had utilized any physician for arthritis care (50.7% versus 41.0%, P = 0.032) and had more often seen an orthopedist (18.1% versus 9.6%, P = 0.006) or general internist (18.5% versus 8.8%, P = 0.002). A diagnosis of rheumatoid arthritis, younger age, living with another person, higher income, and further distance from an arthritis provider were significantly associated with prior rheumatologist utilization. The strongest adjusted predictor of any physician visit for arthritis care was whether older adults drove themselves to their provider. For rheumatologist utilization, a diagnosis of rheumatoid arthritis and age were independently associated.

Conclusions: The most striking finding was the consistent association of need factors (such as the desire for medical advice), joint swelling, and the presence of a diagnosis of rheumatoid arthritis with physician utilization. We identified significant urban-rural variations in factors both enabling and predisposing to arthritis care, although urban-rural status did not appear to independently influence arthritis physician utilization. In a rural state with a relatively small number of rheumatologists, deleterious enabling factors such as greater distance from the doctor and lack of supplemental insurance did not provide significant obstacles to either rheumatologist or generalist utilization.