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Travel Distance and Its Impact on Wait Time for Positron Emission Tomography-Computed Tomography in Patients with Cancers
To examine travel distance and its impact on wait time for positron emission tomography-computed tomography (PET/CT) in patients with lung and prostate cancers and lymphoma in Alberta. We used the Alberta cancer registry and diagnostic imaging database to identify patients with lung and prostate cancers and lymphoma who had a PET/CT scan during April 2017 and March 2023. The Alberta Facilities Distance/Time Look Up Table was used to calculate travel distance from the patient's residence to the PET/CT facility. Negative binomial regression was used to assess the association between travel distance and wait time for PET/CT. The study included 9503 patients. Lung cancer accounted for 43.4% of the patients, followed by lymphoma (37.1%) and prostate (19.5%) cancer. There were more female patients with lung cancer (55.5%) than lymphoma (42.9%;
< 0.001). The mean (SD) age was 66.8 (13.8) years and lymphoma patients were younger (59.6 years) than lung (70.3 years;
< 0.001) or prostate (72.7 years;
< 0.001) cancer patients. Diabetes (14.2%) was the most prevalent comorbidity. The median (IQR) travel distance was 21 (12-121) km and this was shorter for urban (16 km) than rural (148 km;
< 0.001) patients, but the wait time was similar (median = 20 vs. 21 days;
= 0.378). There were no significant associations between travel distance and wait time (IRR = 1.00;
= 0.108). The results were robust in subgroup analyses by type of cancer and scan priority. There were no associations between travel distance and wait time for PET/CT. Additional research is warranted to examine the potential impact of longer travel distances on overall access to care and patient outcomes.
Journal Article
Rural–Urban Disparities in Realized Spatial Access to General Practitioners, Orthopedic Surgeons, and Physiotherapists among People with Osteoarthritis in Alberta, Canada
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.
Journal Article
Informing equitable access to care: a cross-sectional study of travel burden to primary and rheumatology care for people with rheumatoid arthritis
Background
Achieving equity in access to care is a priority at both national and provincial levels in Canada to address health disparities. However, equitable access remains a challenge due to significantly higher rheumatoid arthritis (RA) prevalence in vast rural areas, whereas the RA care providers are primarily concentrated in the two largest cities. Rural-urban disparities in access may be partially attributed to geographic barriers. It is important to measure travel burden of people with RA for developing targeted interventions and policies to mitigate identified geographic barriers and informing equitable access to health care.
Methods
A cross-sectional study was conducted between April 1, 2019 and March 31, 2020 for people with RA in Alberta, Canada. RA cohort was identified using a validated RA case definition based on administrative health data. Travel time between patients’ postal codes and providers’ clinic postal codes was calculated using network analysis. Median travel time was reported at geographic area level. Wilcoxon Rank Sum Test was applied to test the statistical significance between rural-urban categories. The distance decay effect of travel time on health care utilizaton was modelled using a reverse cumulative probability approach.
Results
RA patients took a median of 13 min (IQR: 5–28) to visit general practitioners (GPs) and 34 min (IQR: 21–51) to visit rheumatologists. There were significant rural-urban disparities in access to GP and rheumatology care. The results showed a 4-fold difference in GP travel time (remote areas:5 min, IQR 5–79; moderate metro:20 min, IQR 7–34) and 8.7-fold difference to rheumatologist visit (remote: 226 min, IQR 165–331; metro: 26 min, IQR 17–36) across the rural-urban continuum. Remote patients experienced the longest travel time to rheumatology care but the shortest median travel time to GP care. In remote areas, travel time showed the weakest impact on health care utilization compared to other rural-urban continuum.
Conclusions
Measuring the travel burden for people with RA to access care reveals patterns about the differences in how far patients travelled to seek RA care based on their residential geographic location. These findings will provide evidence to inform health care planning and address observed disparities towards the goal of achieving equitable care.
Journal Article
Geospatial patterns of comorbidity prevalence among people with osteoarthritis in Alberta Canada
Background
Knowledge of geospatial pattern in comorbidities prevalence is critical to an understanding of the local health needs among people with osteoarthritis (OA). It provides valuable information for targeting optimal OA treatment and management at the local level. However, there is, at present, limited evidence about the geospatial pattern of comorbidity prevalence in Alberta, Canada.
Methods
Five administrative health datasets were linked to identify OA cases and comorbidities using validated case definitions. We explored the geospatial pattern in comorbidity prevalence at two standard geographic areas levels defined by the Alberta Health Services: descriptive analysis at rural-urban continuum level; spatial analysis (global Moran’s I, hot spot analysis, cluster and outlier analysis) at the local geographic area (LGA) level. We compared area-level indicators in comorbidities hotspots to those in the rest of Alberta (non-hotspots).
Results
Among 359,638 OA cases in 2013, approximately 60% of people resided in Metro and Urban areas, compared to 2% in Rural Remote areas. All comorbidity groups exhibited statistically significant spatial autocorrelation (hypertension: Moran’s I index 0.24, z score 4.61). Comorbidity hotspots, except depression, were located primarily in Rural and Rural Remote areas. Depression was more prevalent in Metro (Edmonton-Abbottsfield: 194 cases per 1000 population, 95%CI 192–195) and Urban LGAs (Lethbridge-North: 169, 95%CI 168–171) compared to Rural areas (Fox Creek: 65, 95%CI 63–68). Comorbidities hotspots included a higher percentage of First Nations or Inuit people. People with OA living in hotspots had lower socioeconomic status and less access to care compared to non-hotspots.
Conclusions
The findings highlight notable rural-urban disparities in comorbidities prevalence among people with OA in Alberta, Canada. Our study provides valuable evidence for policy and decision makers to design programs that ensure patients with OA receive optimal health management tailored to their local needs and a reduction in current OA health disparities.
Journal Article
Neighbourhood socioeconomic status modifies the association between anxiety and depression during pregnancy and preterm birth: a Community-based Canadian cohort study
ObjectiveThis study examined the association of anxiety alone, depression alone and the presence of both anxiety and depression with preterm birth (PTB) and further examined whether neighbourhood socioeconomic status (SES) modified this association.DesignCohort study using individual-level data from two community-based prospective pregnancy cohort studies (All Our Families; AOF) and Alberta Pregnancy Outcomes and Nutrition (APrON) and neighbourhood SES data from the 2011 Canadian census.SettingCalgary, Alberta, Canada.ParticipantsOverall, 5538 pregnant women who were <27 weeks of gestation and >15 years old were enrolled in the cohort studies between 2008 and 2012. 3341 women participated in the AOF study and 2187 women participated in the APrON study, with 231 women participated in both studies. Women who participated in both studies were only counted once.Primary and secondary outcome measuresPTB was defined as delivery prior to 37 weeks of gestation. Depression was defined as an Edinburgh Postnatal Depression Scale (EPDS) score of ≥13, anxiety was defined as an EPDS-anxiety subscale score of ≥6, and the presence of both anxiety and depression was defined as meeting both anxiety and depression definitions.ResultsOverall, 7.3% of women delivered preterm infants. The presence of both anxiety and depression, but neither of these conditions alone, was significantly associated with PTB (OR 1.6, 95% CI 1.1 to 2.3) and had significant interaction with neighbourhood deprivation (p=0.004). The predicted probability of PTB for women with both anxiety and depression was 10.0%, which increased to 15.7% if they lived in the most deprived neighbourhoods and decreased to 1.4% if they lived in the least deprived neighbourhoods.ConclusionsEffects of anxiety and depression on risk of PTB differ depending on where women live. This understanding may guide the identification of women at increased risk for PTB and allocation of resources for early identification and management of anxiety and depression.
Journal Article
Rural–Urban Differences in Non-Local Primary Care Utilization among People with Osteoarthritis: The Role of Area-Level Factors
The utilization of non-local primary care physicians (PCP) is a key primary care indicator identified by Alberta Health to support evidence-based healthcare planning. This study aims to identify area-level factors that are significantly associated with non-local PCP utilization and to examine if these associations vary between rural and urban areas. We examined rural–urban differences in the associations between non-local PCP utilization and area-level factors using multivariate linear regression and geographically weighted regression (GWR) models. Global Moran’s I and Gi* hot spot analyses were applied to identify spatial autocorrelation and hot spots/cold spots of non-local PCP utilization. We observed significant rural–urban differences in the non-local PCP utilization. Both GWR and multivariate linear regression model identified two significant factors (median travel time and percentage of low-income families) with non-local PCP utilization in both rural and urban areas. Discontinuity of care was significantly associated with non-local PCP in the southwest, while the percentage of people having university degree was significant in the north of Alberta. This research will help identify gaps in the utilization of local primary care and provide evidence for health care planning by targeting policies at associated factors to reduce gaps in OA primary care provision.
Journal Article
Postoperative Complications and Emergent Readmission in Children and Adults with Inflammatory Bowel Disease Who Undergo Intestinal Resection: A Population-based Study
Although the nature and frequency of postoperative complications after intestinal resection in patients with inflammatory bowel disease have been previously described, short-term readmission has not been characterized in population-based studies. We therefore assessed the risk of postoperative complications and emergent readmissions after discharge from an intestinal resection.MethodsWe used a Canadian provincial-wide inpatient hospitalization database to identify 2638 Crohn's disease (CD) and 559 ulcerative colitis (UC) admissions with intestinal resection from 2002 to 2011. We identified the cumulative risk of in-hospital complication and emergent readmission within 90 days after discharge along with predictors for both outcomes using a Poisson regression for binary outcomes.ResultsThe cumulative risks of in-hospital postoperative complications and 90-day emergent readmission were 23.8% and 12.6%, respectively in CD and 33.3% and 11.1%, respectively in UC. The predictors for in-hospital postoperative complications for CD and UC included older age, comorbidities, and open laparatomy for CD, additional predictors included emergent admission, stoma surgery, and concurrent resection of both small and large bowel. The predictors for 90-day readmission for CD included a postoperative complication (risk ratio, 1.61; 95% confidence interval, 1.30–2.01), emergent admission (risk ratio, 1.39; 95% confidence interval, 1.12–1.73), and stoma formation (risk ratio, 1.49; 95% confidence interval, 1.15–1.93) at the hospitalization requiring surgery.ConclusionsReadmission and postoperative complications are common after intestinal resection in CD and UC. Clinicians should closely monitor surgical patients who required emergent admission, undergo surgery with stoma formation, or develop in-hospital postoperative complications to anticipate need for readmission or interventions to prevent readmission.
Journal Article
Traveling Towards Timeliness: The Association Between Travel Time and Wait Time for Rheumatoid Arthritis Care
Objectives: The aim was to measure wait times for rheumatologist consultation and disease-modifying antirheumatic drug (DMARD) treatment and examine their association with travel time to primary care practitioners (PCP) and rheumatologists within a centralized intake system, respectively. Methods: Within a centralized intake system serving 4.2 million people, we measured wait time for rheumatologist consultations and DMARD treatment for an RA incidence cohort between 1 April 2015 and 31 March 2020. Wait times were reported as the median with the interquartile range (IQR). Using multivariate logistics regression models, we examined the impact of travel times to primary/rheumatology care on wait times for rheumatologist consultation (28-day benchmark) and DMARD treatment (14-day benchmark). Travel times were defined according to quantiles and pre-defined categories. Results: The median wait time was 47 days (IQR: 18–114) for rheumatologist consultations (36% meeting the benchmark) and 35 days (IQR: 1–132) for DMARD treatment (43% meeting the benchmark). Patients living >120 min away had lower odds of meeting the 28-day consultation benchmark compared with those within 30 min (OR 0.64; 95% CI: 0.42–0.97). Compared with patients driving ≤30 min, lower odds of meeting the 14-day benchmark for DMARD treatment were observed for those driving over 60 min to PCPs (OR 0.62; 95% CI: 0.39–0.99) and patients driving 30–60 min to rheumatologists (OR 0.68; 95% CI: 0.55–0.85). Conclusion: RA management was suboptimal due to low rates of meeting RA consultation and treatment benchmarks, which was significantly associated with long travel times to both primary and RA care within a centralized triage system. This highlights the need for complementary strategies (e.g., tele-rheumatology, travel support, or alternate care providers) to ensure timely RA care in rural and remote communities.
Journal Article
Impacts of the COVID-19 Pandemic on Primary Care Utilization: An Analysis of Primary Care Claims Data in Alberta, Canada
Background:
The COVID-19 pandemic disrupted primary health care systems worldwide, prompting rapid changes in how care was delivered. In Alberta, this included a significant shift from in-person to virtual care. This study examines trends in primary care utilization among Albertans during COVID-19 and the shift toward virtual care.
Methods:
Repeated cross-sectional analyses were conducted from 2018/19 to 2022/23 using Alberta Health Practitioner Claims data. Utilization was measured as the proportion of Albertans with at least one visit and the annual visit rate per person. Annual percent change (APC) was calculated relative to the pre-pandemic year (2019/20) and stratified by demographics.
Findings:
The proportion of Albertans with a primary care visit decreased by −9.55% in 2020/21 but recovered to −4.62% by 2022/23. Annual visit rates remained stable post-pandemic. The largest declines in 2020/21 were among children aged 5 to 11 (−38.42%), ≤4 (−33.42%), newborns (−30.36% to −25.49%), and those without health conditions (−20.9%). Virtual care accounted for 23.77% of visits in 2020/21, dropping to 14.43% by 2022/23.
Conclusions:
While fewer Albertans accessed primary care, visit rates remained stable due to virtual care. Further research is needed to assess the long-term impacts of COVID-19 on primary healthcare delivery.
Journal Article