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Barriers to Providing Adequate Rheumatology Care: Implications from a Survey of Rheumatologists in Ontario, Canada DEBORAH SHIPTON, ELIZABETH M. BADLEY, ARTHUR A. BOOKMAN, and GILLIAN A. HAWKER
ABSTRACT.
Methods. All 158 identified rheumatologists in Ontario were sent a self-administered questionnaire and followed up by telephone. Results. The response rate was 83%. All but 6 rheumatologists reported at least one barrier to the provision of service. The 3 most commonly reported barriers were the cost of drugs for patients (83%), billing policies and regulations for consultation and followup visits (72%), and long waiting times for patients (61%). Rheumatologists reporting the latter had significantly longer waiting times (12 vs 4 wks) for new non-urgent patients, although there was no difference for new patients with inflammatory arthritis. Nearly three-quarters of respondents had changed the patterns of their practice over the last 3 years, with significant increases in the amount of independent medical services (e.g., third party billing) and pharmaceutical company work. The majority (89%) of responding rheumatologists reported having at least some difficulty in making ends meet from rheumatology practice alone and 28% found it was not possible. Conclusion. These results indicate that the majority of rheumatologists face significant barriers to providing adequate care. Given the recruitment and service provision concerns in Canada, these barriers to service need to be addressed to ensure adequate provision of care. (J Rheumatol 2002;29:2420-5) Key Indexing Terms:
RHEUMATOLOGY
From the Arthritis Community Research and Evaluation Unit, Toronto Western Research Institute; the Department of Public Health Sciences, the Department of Medicine, Division of Rheumatology, Faculty of Medicine, University of Toronto; and Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada. Supported by a Health System Linked Health Research Unit Grant from the Ontario Ministry of Health and Long Term Care (Grant 04166) and The Arthritis Society, Ontario Division. D. Shipton, PhD, Arthritis Community Research and Evaluation Unit (ACREU), Toronto Western Research Institute; E.M. Badley, PhD, ACREU, Department of Public Health Sciences, the Department of Medicine, Division of Rheumatology, Faculty of Medicine, University of Toronto; A.A. Bookman, MD, Department of Medicine, Division of Rheumatology, Faculty of Medicine, University of Toronto; G.A. Hawker, MD, ACREU, Department of Medicine, Division of Rheumatology, Faculty of Medicine, University of Toronto, Sunnybrook and Women's College Health Sciences Centre. Address reprint requests to Dr. E.M. Badley, ACREU, Toronto Western Hospital, 399 Bathurst Street, Main Pavilion, 10th Floor, Room 316, Toronto, Ontario M5T 2S8, Canada. Submitted February 13, 2002; revision accepted May 10, 2002.
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