Article Figures & Tables
Tables
- Table 1: Comparison of EMRALD study physicians and all primary care physicians in Ontario as of Mar. 31, 2014
Characteristic No. (%) of physicians* EMRALD physicians
n = 168All primary care physicians in Ontario†
n = 8054Sex Female 94 (56.0) 3333 (41.4) Male 74 (44.0) 4721 (58.6) Age, yr < 35 25 (14.9) 500 (6.2) 35-44 57 (33.9) 1643 (20.4) 45-54 36 (21.4) 2425 (30.1) 55-79 46 (27.4) 3471 (43.1) Unknown 4 (2.4) 15 (0.2) Medical training location Canada 150 (89.3) 5967 (74.1) Elsewhere/unknown 18 (10.7) 2087 (25.9) Practice location Rural 32 (19.0) 608 (7.5) Suburban 39 (23.2) 1313 (16.3) Urban 97 (57.7) 6133 (76.1) Practice model FHG or FHN 18 (10.7) 2795 (34.7) FHO 136 (81.0) 3525 (43.8) Other/unknown 14 (8.3) 1734 (21.5) Age, yr, mean (range) 46.6 (28-69) 52.2 (27-79) Years in practice, mean (range) 15.2 (1-36) 18.5 (0-45) Years since graduation, mean (range) 19.9 (3-43) 26.3 (2-65) Note: EMRALD = Electronic Medical Record Administrative data Linked Database, FHG = Family Health Group, FHN = Family Health Network, FHO = Family Health Organization.
*Unless stated otherwise.
†Primary care physicians whose practice was focused on primary care were defined as having a main specialty of general practice/family practice or community medicine/public health.
Diagnosis No. of patients Age, yr,
mean ± SDFemale,
no. (%)All patients 2430 53.0 ± 16.3 1682 (69.2) Osteoarthritis 787 56.4 ± 15.6 554 (70.4) Systemic inflammatory rheumatic disease 745 53.4 ± 17.0 427 (57.3) Rheumatoid arthritis 120 55.4 ± 15.8 84 (70.0) Inflammatory arthritis, other 167 50.9 ± 16.2 95 (56.9) Crystal arthropathy 122 61.3 ± 15.3 33 (27.0) Spondylitis/spondyloarthropathy 76 41.5 ± 15.2 31 (40.8) Psoriatic arthritis 44 52.9 ± 12.6 26 (59.1) Polymyalgia rheumatica 66 71.2 ± 9.2 41 (62.1) Vasculitis 19 52.7 ± 23.5 10 (52.6) Other systemic autoimmune rheumatic disease 131 45.3 ± 13.9 107 (81.7) Regional musculoskeletal syndrome 395 52.2 ± 15.8 286 (72.4) Chronic pain condition 346 46.5 ± 14.3 298 (86.1) Osteoporosis 45 62.3 ± 15.2 38 (84.4) Other 112 46.3 ± 16.3 79 (70.5) Reason No. (%) of patients
n = 2430Patient declined or missed consultation after first referral sent 68 (2.8) Symptoms resolved 6 (8.8) Patient choice 21 (30.9) Patient unavailable/missed appointment 26 (38.2) Rheumatologist declined consultation after first referral sent 87 (3.6) Consulted only for certain conditions 23 (26.4) Rheumatologist suggested alternative plan (e.g., pain clinic, another specialist) 21 (24.1) No reason provided 19 (21.8) Not accepting new patients 10 (11.5) Diagnosis No. of patients No. (%) seen by rheumatologist within: Wait time, d, median (IQR) Wait time percentile, d* 4 wk 6 wk 3 mo 6 mo 9 mo 12 mo 50th 90th All patients 2430 579 (23.8) 846 (34.8) 1414 (58.2) 1839 (75.7) 1963 (80.8) 2015 (82.9) 74 (27-101) 57 170 Osteoarthritis 787 168 (21.3) 249 (31.6) 454 (57.7) 601 (76.4) 640 (81.3) 661 (84.0) 73 (30-103) 62 174 Systemic inflammatory rheumatic disease 745 242 (32.5) 333 (44.7) 496 (66.6) 597 (80.1) 629 (84.4) 643 (86.3) 66 (18-84) 43 155 Rheumatoid arthritis 120 46 (38.3)† 57 (47.5) 85 (70.8) 95 (79.2) 101 (84.2) 104 (86.7) 66 (15-81) 37 166 Inflammatory arthritis, other 167 59 (35.3)† 85 (50.9) 117 (70.1) 133 (79.6) 139 (83.2) 143 (85.6) 55 (17-71) 38 128 Crystal arthropathy 122 33 (27.0) 51 (41.8) 78 (63.9) 101 (82.8) 107 (87.7) 108 (88.5) 69 (24-93) 52 156 Spondylitis/
spondyloarthropathy76 17 (22.4) 24 (31.6) 48 (63.2)† 63 (82.9) 65 (85.5) 65 (85.5) 62 (29-91) 58 146 Psoriatic arthritis 44 11 (25.0) 15 (34.1)† 26 (59.1) 38 (86.4) 42 (95.4) 43 (97.7) 88 (30-117) 56 189 Polymyalgia rheumatica 66 31 (47.0) 36 (54.5) 47 (71.2) 54 (81.8) 57 (86.4) 58 (87.9) 53 (11-64) 27 131 Vasculitis 19 10 (52.6) 12 (63.2) 14 (73.7) 14 (73.7) 15 (78.9) 15 (78.9) 28 (11-39) 16 71 Other systemic autoimmune rheumatic disease 131 35 (26.7) 53 (40.5) 81 (61.8) 99 (75.6) 103 (78.6) 107 (81.7) 62 (22-83) 46 137 Regional musculoskeletal syndrome 395 99 (25.1) 145 (36.7) 240 (60.8) 307 (77.7) 323 (81.8) 330 (83.5) 68 (26-94) 53 152 Chronic pain condition 346 51 (14.7) 88 (25.4) 161 (46.5) 236 (68.2) 263 (76.0) 271 (78.3) 90 (35-125) 72 204 Osteoporosis 45 NR‡ NR‡ 9 (20.0) 24 (53.3) 28 (62.2) 28 (62.2) 82 (74-156) 118 183 Other 112 16 (14.3) 27 (24.1) 54 (48.2) 74 (66.1) 80 (71.4) 82 (73.2) 69 (40-110) 69 175 Note: IQR = interquartile range, NR = not reportable.
*The 50th percentile reflects that 50% of the patients had seen a rheumatologist within this time frame and 50% were still waiting; the 90th percentile reflects that 90% of patients had seen a rheumatologist within this time frame and 10% were still waiting.
†Benchmark target = 100%.
‡Suppressed to protect privacy.
- Table 5: Median wait time from symptom onset to rheumatologist consultation for systemic inflammatory rheumatic diseases*
Variable Rheumatoid arthritis
n = 101Inflammatory arthritis, other
n = 147Crystal arthropathy
n = 97Spondylitis/ spondylo-arthropathy
n = 56Psoriatic arthritis
n = 35Polymyalgia rheumatica
n = 60Vasculitis
n = 18Other systemic autoimmune rheumatic disease
n = 96Median wait time (IQR), d Symptom onset to primary care visit† 173
(16-189)102
(10-112)188
(4-192)716
(14-730)228
(17-245)63
(14-77)128
(3-131)208
(14-222)Primary care visit to referral‡ 115
(14-128)125
(11-136)353
(20-373)173
(7-181)513
(15-528)123
(15-138)73
(7-80)181
(7-188)Symptom onset to referral 326
(49-375)259
(41-300)1326
(48-1374)1342
(63-1405)627
(90-7167)238
(55-293)293
(33-325)855
(44-899)Referral to rheumatologist consultation§ 66
(15-81)55
(17-71)69
(24-93)62
(29-91)88
(30-117)53
(11-64)28
(11-39)62
(22-83)Symptom onset to rheumatologist consultation 327
(83-410)260
(91-350)1312
(111-1423)1262
(112-1374)680
(125-805)240
(81-321)608
(59-667)940
(113-1053)No. (%) of patients seen by rheumatologist within: 3 mo from symptom onset 24 (24) 31 (21) 15 (15) 8 (14) NR¶ 17 (28) NR¶ 16 (17) 6 mo from symptom onset 42 (42) 67 (46) 34 (35) 19 (34) 12 (34) 32 (53) 7 (39) 29 (30) 9 mo from symptom onset 50 (50) 86 (59) 44 (45) 22 (39) 15 (43) 38 (63) 8 (44) 40 (42) 12 mo from symptom onset 60 (59) 97 (66) 46 (47) 23 (41) 17 (49) 43 (72) 10 (56) 45 (47) Note: IQR = interquartile range, NR = not reportable.
*Analyses confined to patients with date of symptom onset captured in their medical record.
†Defined as first documentation of the complaint within the primary care medical record.
‡Defined as the date the referral was sent to the rheumatologist.
§Defined as the first visit to the rheumatologist.
¶Suppressed to protect privacy.
- Table 6: Median wait time from referral to rheumatologist consultation, by patient's health service planning region (LHIN)
LHIN no. LHIN No. (%) of patients Median wait time (IQR), d No. of rheumatologists in 2009/10 No. of rheumatologists per 100 000 13 North East 190 (7.8) 55.0 (37.0-92.0) < 6 0.2 3 Waterloo Wellington 405 (16.7) 77.5 (28.0-105.5) < 6 0.5 1 Erie St. Clair NR* NR* < 6 0.7 5 Central West 90 (3.7) 103.0 (41.0-144.0) < 6 0.8 12 North Simcoe Muskoka 224 (9.2) 77.5 (25.5-103.0) < 6 0.8 9 Central East 184 (7.6) 46.3 (32.0-78.3) 12 0.9 14 North West NR* NR* < 6 1.0 2 South West 182 (7.5) 146.5 (34.3-180.8) 9 1.1 6 Mississauga Halton 29 (1.2) 65.0 (17.0-82.0) 11 1.2 8 Central 365 (15.0) 72.3 (27.0-99.3) 18 1.3 10 South East 13 (0.5) 125.2 (30.8-156.0) 6 1.4 4 Hamilton Niagara Haldimand Brant 67 (2.8) 71.2 (24.3-95.5) 19 1.6 11 Champlain 166 (6.8) 112.2 (49.8-162.0) 19 1.8 7 Toronto Central 509 (20.9) 59.0 (15.0-74.0) 50 5.2 - All Ontario regions 2430 (100.0) 74.0 (27.0-101.0) 162 1.5 Note: IQR = interquartile range, LHIN = Local Health Integration Network, NR = not reportable.
*Suppressed to protect privacy.