Arthritis and Related Conditions

216 Pages·2013·4.02 MB·English

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: [phone]
Fax: [phone]
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