PAT T E R N S O F H E A LT H C A R E I N O N TA R I O An ICES Practice Atlas PAT TERNS OF HEALTH CARE IN ONTARIO Arthritis & Related Conditions An ICES Practice Atlas Editors Elizabeth M. Badley J. Ivan Williams INSTITUTE FOR CLINICAL EVALUATIVE SCIENCES Published by Institute for Clinical Evaluative Sciences Cover design by Laura Benben – Graphic Designer, ICES Interior design and page layout by Laura Benben – Graphic Designer, ICES and Rick Eskins, Freelance Graphic Designer Printed by Continental Press ©1998 Institute for Clinical Evaluative Sciences All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the proper written permission of the publisher. Canadian Cataloguing in Publication Data Patterns of health care in Ontario: arthritis & related conditions: an ICES practice atlas Includes bibliographical references and index. ISBN 0-9699405-3-X 1. Arthritis–Ontario. 2. Osteoporosis–Ontario. 3. Medical care–Utilization–Ontario. 4. Health services accessibility–Ontario. I. Badley, Elizabeth M. (Elizabeth Mary), 1946-. II. Williams, J. Ivan (Jack Ivan), 1939-. III. Institute for Clinical Evaluative Sciences in Ontario. IV. Title: Arthritis & related conditions. V. Title: Arthritis and related conditions. RC933.P38 1998 362.1’96722’009713 C98-900900-9 How to cite the ICES Practice Atlas: The production of the ICES Practice Atlas was a collaborative venture. Accordingly, to give credit to individual authors, please cite individual chapters using chapter authors and title, in addition to editors and book title. For example, for Chapter 9: Coyte P, Axcell T, The Use of and Regional Variations in Post-Acute Rehabilitation Services for Musculoskeletal Patients. In Williams JI, Badley EM (eds). Patterns of Health Care in Ontario: Arthritis and Related Conditions. Additional copies are available from: Institute for Clinical Evaluative Sciences G 106, 2075 Bayview Avenue North York, Ontario M4N 3M5 Telephone: (416) 480-4055 Fax: (416) 480-6048 E-mail: [email protected] Table of Contents Patterns of Health Care in Ontario: Arthritis and Related Conditions Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xiii Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xv Elizabeth Badley, J. Ivan Williams Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xix Elizabeth Badley, J. Ivan Williams Chapter 1 Epidemiology of Arthritis and Osteoporosis . . . . . . . . . . . . . . . . . . . . . . .1 Gillian Hawker Chapter 2 Estimating the Impact of Arthritis on the Burden of Disability and the Costs of Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 J. Ivan Williams, Karey Iron, Keyi Wu Chapter 3 The Economic Cost of Arthritis and Rheumatism in Canada . . . . . . . . . .27 Peter Coyte, Carl Asche, Ruth Croxford, Ben Chan Chapter 4 Availability of Services for People with Arthritis . . . . . . . . . . . . . . . . . . .35 Elizabeth Badley, Linda Rothman, Marlene R. Stephens, Micheline Wong i Chapter 5 The Role of Primary Care Physicians in Treating Arthritis . . . . . . . . . . .63 Rick Glazier Primary Care and the Ontario Health Survey . . . . . . . . . . . . . . . . . .64 Rick Glazier, Elizabeth Badley Ambulatory Primary Care Visits in Ontario . . . . . . . . . . . . . . . . . . . . .67 Rick Glazier, Julie Arnold ACREU Survey of Ontario Family Physicians . . . . . . . . . . . . . . . . . . . .70 Rick Glazier, Dawn Dalby, Elizabeth Badley, Gillian Hawker, Mary Bell, Sydney Lineker, Rachelle Buchbinder, Sara McConnell Chapter 6 Use of Medication for Arthritis and Related Conditions . . . . . . . . . . . . .93 Albert J. Kirshen Chapter 7 Surgical Services for Total Hip and Total Knee Replacements . . . . . . . .111 Overall Trends in Hip and Knee Replacements . . . . . . . . . . . . . . .113 Don DeBoer, J. Ivan Williams Trends in Hospital Volumes and Length of Stay for Total Hip and Total Knee Replacement . . . . . . . . . . . . . . . . . . . . . . . .121 Don DeBoer, J. Ivan Williams Costs of Prostheses in Total Hip and Total Knee Replacements . . . . .124 Mark Cheung, Michael Paterson, Elaine Gort, J. Ivan Williams Volumes and Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .127 Hans Kreder, Tami Axcell, J. Ivan Williams Times in the Surgeon’s Queue for Elective Primary Total Hip and Total Knee Replacements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .133 Tami Axcell, Don DeBoer, Hans Kreder, J. Ivan Williams Chapter 8 Osteoporotic Fractures: Incidence and Impact . . . . . . . . . . . . . . . . . .143 Susan Jaglal Chapter 9 The Use of and Regional Variations in Post-acute Rehabilitation Services for Musculoskeletal Patients . . . . . . . . . . . . . .157 Peter Coyte, Tami Axcell Chapter 10 Issues in Health Care for Arthritis and Related Conditions . . . . . . . . .171 Elizabeth Badley, J. Ivan Williams Technical Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .183 J. Ivan Williams Index Listings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .171 ii Contributors Practice Atlas Contributors Julie Arnold Rachelle Buchbinder Arthritis Community Research and Evaluation Unit Monash Medical School, Melbourne Australia Carl Asche Ben Chan Department of Economics, University of Surrey, England Institute for Clinical Evaluative Sciences Health Economics and Outcomes Research, Departments of Health Administration and Public Health Bristol Myers Squibb Canada Inc., Montreal Sciences and Biostatistics, University of Toronto Tami Axcell Mark Cheung Institute for Clinical Evaluative Sciences Institute for Clinical Evaluative Sciences Elizabeth Badley Peter Coyte Arthritis Community Research and Evaluation Unit Institute for Clinical Evaluative Sciences The Toronto Hospital Clinical Epidemiology Unit, Department of Public Health Sciences Sunnybrook Health Science Centre Graduate Departments of Community Health and Department of Health Administration, Rehabilitation Sciences; and Institute of Medical Sciences University of Toronto University of Toronto Arthritis Community Research and Evaluation Unit Mary Bell University of Toronto Ruth Croxford Sunnybrook Health Science Centre Clinical Epidemiology Unit, Sunnybrook Health Science Centre Arthritis Community Research and Evaluation Unit iii Dawn Dalby Linda Rothman Arthritis Community Research and Evaluation Unit Arthritis Community Research and Evaluation Unit Department of Occupational Therapy, Donald DeBoer University of Toronto Institute for Clinical Evaluative Sciences Marlene R. Stephens Richard Glazier Arthritis Community Research and Evaluation Unit Department of Family and Community Medicine, University of Toronto J. Ivan Williams Clinical Epidemiology and Health Care Research Program, Institute for Clinical Evaluative Sciences University of Toronto Clinical Epidemiology and Health Care Research Unit, Arthritis Community Research and Evaluation Unit, Sunnybrook Health Science Centre The Toronto Hospital Departments of Family and Community Medicine, St. Michael’s Hospital Inner City Health Program Public Health Sciences, Community Denistry; Graduate Departments of Community Health, Nursing Science and Rehabilitation Science; and, Elaine Gort Institute of Medical Science, University of Toronto Institute for Clinical Evaluative Sciences Micheline Wong Gillian Hawker Arthritis Community Research and Evaluation Unit Women’s College Hospital Faculty of Medicine, University of Toronto Keyi Wu Arthritis Community Research and Evaluation Unit Institute for Clinical Evaluative Sciences Karey Iron Institute for Clinical Evaluative Sciences Susan Jaglal M.E Müller Program in Research, Sunnybrook Health Science Centre Clinical Epidemiology and Health Care Research Unit, Sunnybrook Health Science Centre Institute for Clinical Evaluative Sciences Department of Public Health Sciences, University of Toronto Albert J. Kirshen Kunen-Lunenfeld Applied Research Unit, Baycrest Centre for Geriatric Care Institute for Clinical Evaluative Sciences Division of Geriatric Medicine, Faculty of Medicine, University of Toronto Hans Kreder Division of Orthopedic Surgery, University of Toronto Sunnybrook Health Science Centre Institute for Clinical Evaluative Sciences Clinical Epidemiology and Health Care Research Program, University of Toronto Sydney Lineker The Arthritis Society, Ontario Division Arthritis Community Research and Evaluation Unit Sara McConnell Arthritis Community Research and Evaluation Unit Michael Paterson Institute for Clinical Evaluative Sciences iv Exhibits & Appendices Introduction Exhibit 2.5: Age/Sex-specific Percentages of Persons With and Without Arthritis with Chronic Exhibit 1: Prevalence of and Number of Persons Conditions 15 Years and Over in Ontario, with Arthritis Aged 15 Years and Over 1994/95 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 in Ontario, 1990 . . . . . . . . . . . . . . . . . . . . . . . . .xx Exhibit 2.6: Age/Sex-specific Percentages of Persons With and Without Arthritis with Restrictions Chapter 2 in Activity 15 Years and Over in Ontario, 1994/95 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 Estimating the Impact of Arthritis on the Burden Exhibit 2.7: Age/Sex-specific Percentages of Persons of Disability and the Costs of Health Services With and Without Arthritis with Long-Term Exhibit 2.1: Age/Sex-specific Arthritis Rates Disability 15 Years and Over in Ontario, per 1,000 Population 15 Years and Over 1994/95 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16 in Ontario, 1994/95 . . . . . . . . . . . . . . . . . . . . . .12 Exhibit 2.8: Age/Sex-specific Percentages of Persons Exhibit 2.2: Demographic, Social and Economic With and Without Arthritis with Moderate Indicators of National Population Health to Severe Pain 15 Years and Over in Ontario, Survey Respondents With and Without 1994/95 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16 Arthritis by Sex in Ontario, 1994/95 . . . . . . . . . .13 Exhibit 2.9: Age/Sex-specific Percentages of Persons Exhibit 2.3: Age/Sex-specific Percentages of Persons With and Without Arthritis Taking With and Without Arthritis Who Worked Medication for Pain 15 Years and Over in the Past Year 15 Years and Over in Ontario, 1994/95 . . . . . . . . . . . . . . . . . . . . . .17 in Ontario, 1994/95 . . . . . . . . . . . . . . . . . . . . . .14 Exhibit 2.10:Age/Sex-specific Percentages of Persons Exhibit 2.4: Age/Sex-specific Percentages of Persons With and Without Arthritis Experiencing With and Without Arthritis Who Rate Some Chronic Stress 15 Years and Over Health as Fair or Poor 15 Years and Over in Ontario, 1994/95 . . . . . . . . . . . . . . . . . . . . . .17 in Ontario, 1994/95 . . . . . . . . . . . . . . . . . . . . . .14 v Exhibit 2.11:Age/Sex-specific Percentages of Persons Chapter 4 With and Without Arthritis with Case Depression 15 Years and Over in Ontario, The Availability of Services for People with Arthritis 1994/95 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 Exhibit 4.1: Availability of Rheumatology and Orthopedic Exhibit 2.12:Age/Sex-specific Percentages of Persons Services by Health Planning Region and With and Without Arthritis with Disability District Health Council per 100,000 Score on Health Utility Index (<0.830) Population in Ontario, 1997 . . . . . . . . . . . . . . . .38 15 Years and Over in Ontario, 1994/95 . . . . . . . .18 Exhibit 4.2: Availability of Rheumatology and Orthopedic Exhibit 2.13:Age/Sex-specific Percentages of Inpatient Services by Health Planning Region and Admissions Over Two Years per 1,000 Persons New District Health Council per 100,000 With and Without Arthritis 15 Years and Over Population in Ontario . . . . . . . . . . . . . . . . . . . . .39 in Ontario, 1994/95 – 1996/97 . . . . . . . . . . . . . .19 Exhibit 4.3: Availability of Rheumatology Services Exhibit 2.14:Age/Sex-specific Percentages of Mean Half-Days/Week per 100,000 Population Resource Intensity Weights® per Inpatient (all ages) by District Health Council Admission for Persons With and Without in Ontario, 1997 . . . . . . . . . . . . . . . . . . . . . . . . .40 Arthritis 15 Years and Over in Ontario, Exhibit 4.4: Mean Wait Time (weeks) for Rheumatology 1994/95 – 1996/97 . . . . . . . . . . . . . . . . . . . . . . .19 Services by District Health Council Exhibit 2.15:Age/Sex-specific Same-Day Surgery in Ontario, 1997 . . . . . . . . . . . . . . . . . . . . . . . . .41 Admissions per 1,000 Persons With and Exhibit 4.5: Availability of Orthopedic Services Office Without Arthritis 15 Years and Over & Surgery Half-Days/Week per 100,000 in Ontario, 1994/95 – 1996/97 . . . . . . . . . . . . . .20 Population (all ages) by District Health Exhibit 2.16:Age/Sex-specific Mean Resource Intensity Council in Ontario, 1997 . . . . . . . . . . . . . . . . . . .43 Weights® per Same-Day Surgery Procedure for Exhibit 4.6: Availability of Orthopedic Services Office Persons With and Without Arthritis 15 Years Half-Days/Week per 100,000 Population and Over in Ontario, 1994/95 – 1996/97 . . . . . .20 (all ages) by District Health Council Exhibit 2.17:Age/Sex-specific Ontario Health Insurance in Ontario, 1997 . . . . . . . . . . . . . . . . . . . . . . . . .44 Plan Claims per 1,000 Persons With and Exhibit 4.7: Availability of Orthopedic Surgery Without Arthritis 15 Years and Over Half-Days/Week per 100,000 Population in Ontario, 1994/95 – 1996/97 . . . . . . . . . . . . . .21 (all ages) by District Health Council Exhibit 2.18:Age/Sex-specific Ontario Drug Benefit in Ontario, 1997 . . . . . . . . . . . . . . . . . . . . . . . . .45 Program Claims per 1,000 Persons With Exhibit 4.8: Availability of Selected Services by and Without Arthritis 65 Years and Over Health Planning Region and District in Ontario, 1994/95 – 1996/97 . . . . . . . . . . . . . .21 Health Council per 100,000 Population Exhibit 2.19:Sex-specific Average Annual Cost for in Ontario . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46 Health Services for Persons With and Without Exhibit 4.9: Availability of Selected Services by Arthritis in Ontario, 1994/95 – 1996/97 . . . . . . .22 Health Planning Region and New District Appendix A2.1: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 Health Council per 100,000 Population in Ontario . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47 Chapter 3 Exhibit 4.10:Availability of General Practitioners per 100,000 Population (all ages) by The Economic Cost of Arthritis and Rheumatism District Health Council in Ontario, 1990 . . . . . . .48 in Canada Exhibit 4.11:Availability of Chiropractors per 100,000 Population (all ages) by District Health Exhibit 3.1: Economic Cost of Arthritis and Rheumatism Council in Ontario, 1996 . . . . . . . . . . . . . . . . . . .49 for Canadians Under Various Costing Scenarios in 1994 Canadian Dollars . . . . . . . . . .29 Exhibit 4.12:Availability of Physiotherapy Services (Arthritis-Related Practice) per 100,000 Appendix A3.1: Definitions and Data Sources for Population (all ages) by District Health Health Care Cost Categories . . . . . . . . . . . . .33 Council in Ontario, 1996 . . . . . . . . . . . . . . . . . . .50 Appendix A3.2: Alternative Assumptions Used in the Exhibit 4.13:Availability of Occupational Therapists Cost-of-Illness Sensitivity Analysis . . . . . . . . .34 per 100,000 Population (all ages) by District Health Council in Ontario, 1997 . . . . . . .51 vi
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