Magnitude of impact and healthcare use for musculoskeletal disorders in the paediaric: A population-based study

Background: Although musculoskeletal disorders (MSD) are among the most prevalent chronic conditions, minimal attention has been paid to the paediatric population. The aim of this study is to describe the annual prevalence of healthcare contacts for MSD by children and youth age 0-19years, including type of MSD, care delivery setting and the specialty of the physician consulted. Methods. Analysis of data on all children with healthcare contacts for MSD in Ontario, Canada using data from universal health insurance databases on ambulatory physician and emergency department (ED) visits, same-day outpatient surgery, and in-patient admissions for the fiscal year 2006/07. The proportion of children and youth seeing different physician specialties was calculated for each physician and condition grouping. Census data for the 2006 Ontario population was used to calculate person visit rates. Results: 122.1 per 1,000 children and youth made visits for MSD. The majority visited for injury and related conditions (63.2 per 1,000), followed by unspecified MSD complaints (33.0 per 1,000), arthritis and related conditions (27.7 per 1,000), bone and spinal conditions (14.2 per 1,000), and congenital anomalies (3 per 1,000). Injury was the most common reason for ED visits and in-patient admissions, and arthritis and related conditions for day-surgery. The majority of children presented to primary care physicians (74.4%), surgeons (22.3%), and paediatricians (10.1%). Paediatricians were more likely to see younger children and those with congenital anomalies or arthritis and related conditions. Conclusion: One in eight children and youth make physician visits for MSD in a year, suggesting that the prevalence of MSD in children may have been previously underestimated. Although most children may have self-limiting conditions, it is unknown to what extent these may deter involvement in physical activity, or be indicators of serious and potentially life-threatening conditions. Given deficiencies in medical education, particularly of primary care physicians and paediatricians, it is important that training programs devote an appropriate amount of time to paediatric MSD. © 2012 Gunz et al.; licensee BioMed Central Ltd

Visits to rheumatologists for arthritis: The role of access to primary care physicians, geographic availability of rheumatologists, and socioeconomic status

Objective. This multilevel study examines access to rheumatologists for all arthritis and inflammatory arthritis, taking into account geographic availability of rheumatologists, access to primary care physicians (PCPs), and population characteristics (e.g., socioeconomic status [SES]). Methods. We analyzed data from the population (age ≤18 years) living in the 105 health planning areas in Ontario, Canada on visits to physicians for arthritis and musculoskeletal disorders. Using data from a survey of rheumatologists and Geographic Information System analysis, an index of geographic availability for rheumatologists was calculated, incorporating distance between the population and rheumatologist locations and the number of hours per week of rheumatologist care. Multilevel Poisson regression was used to examine factors associated with the rates of rheumatology visits for inflammatory arthritis and all arthritis. Results. Controlling for age and sex, the rheumatologist availability index was associated with visit rates for all arthritis, but not inflammatory arthritis. Patients living in areas with low access to PCPs or low SES were less likely to have office visits to rheumatologists for all arthritis and inflammatory arthritis. Conclusion. Besides potential deficiencies in rheumatology provision, there may be access barriers to rheumatology services, particularly for populations with low access to PCPs or low SES. This is of special concern for patients with inflammatory arthritis for whom rheumatologist care is necessary. In developing models of care for arthritis, this study points to the need to pay attention to areas with low PCP resources and areas of low SES, as well as the location and amount of rheumatology services available

A population-based study of ambulatory and surgical services provided by orthopaedic surgeons for musculoskeletal conditions

<p>Abstract</p> <p>Background</p> <p>The ongoing process of population aging is associated with an increase in prevalence of musculoskeletal conditions with a concomitant increase in the demand of orthopaedic services. Shortages of orthopaedic services have been documented in Canada and elsewhere. This population-based study describes the number of patients seen by orthopaedic surgeons in office and hospital settings to set the scene for the development of strategies that could maximize the availability of orthopaedic resources.</p> <p>Methods</p> <p>Administrative data from the Ontario Health Insurance Plan and Canadian Institute for Health Information hospital separation databases for the 2005/06 fiscal year were used to identify individuals accessing orthopaedic services in Ontario, Canada. The number of patients with encounters with orthopaedic surgeons, the number of encounters and the number of surgeries carried out by orthopaedic surgeons were estimated according to condition groups, service location, patient's age and sex.</p> <p>Results</p> <p>In 2005/06, over 520,000 Ontarians (41 per 1,000 population) had over 1.3 million encounters with orthopaedic surgeons. Of those 86% were ambulatory encounters and 14% were in hospital encounters. The majority of ambulatory encounters were for an injury or related condition (44%) followed by arthritis and related conditions (37%). Osteoarthritis accounted for 16% of all ambulatory encounters. Orthopaedic surgeons carried out over 140,000 surgeries in 2005/06: joint replacement accounted for 25% of all orthopaedic surgeries, whereas closed repair accounted for 16% and reductions accounted for 21%. Half of the orthopaedic surgeries were for arthritis and related conditions.</p> <p>Conclusion</p> <p>The large volume of ambulatory care points to the significant contribution of orthopaedic surgeons to the medical management of chronic musculoskeletal conditions including arthritis and injuries. The findings highlight that surgery is only one component of the work of orthopaedic surgeons in the management of these conditions. Policy makers and orthopaedic surgeons need to be creative in developing strategies to accommodate the growing workload of orthopaedic surgeons without sacrificing quality of care of patients with musculoskeletal conditions.</p

AN AGE-PERIOD-COHORT ANALYSIS OF HEALTH STATUS AND HEALTHCARE USE IN CANADA: ARE BABY BOOMERS DIFFERENT FROM OTHER GENERATIONS?

BACKGROUND: There are concerns for the provision of healthcare services in Canada given the large numbers of ageing baby boomers. However, little is known about how they differ in their health profile and patterns of healthcare use compared to other generations. This thesis describes three studies, based on a longitudinal survey of the population, examining the trajectories of multimorbidity and healthcare use (i.e. conventional care and complementary and alternative medicine (CAM)) across five birth cohorts. METHODS: Using data from the Longitudinal National Population Health Survey (1994-2011), the thesis studies examined 10186 participants belonging to one of the five birth cohorts: pre World War II (born: 1925-1934), World War II (born: 1935-1944), older (born: 1945-1954) and younger (born: 1955-1964) baby boomers, and Generation X (Gen Xers, born: 1965-1974). Hierarchical age-period-cohort analysis was used to examine the contributions of age (life-course), period, and cohort effects in changes in multimorbidity, use of conventional care (i.e. primary care and specialist services users), and CAM use. RESULTS: Each succeeding recent cohort had higher odds of reporting multimorbidity than their predecessors. Furthermore, Gen Xers and younger boomers, particularly those with multimorbidity, were less likely to use primary care than earlier cohorts. The increasing levels of multimorbidity explained the higher specialist use observed in recent cohorts. Likewise, at corresponding ages, more recent cohorts reported greater chiropractic and CAM use than their predecessors. The use of conventional care was positively related to greater CAM use, but did not contribute to changes over time or to cohort differences in CAM use. CONCLUSIONS: There is a need for policies addressing important generational differences in healthcare preferences and the balance between primary and specialty care to ensure integration and coordination of healthcare delivery. The findings also highlight the importance of planning interventions and policies to deal with more recent birth cohorts entering into older age with worse health than previous generations.Ph.D

Generational differences in patterns of physical activities over time in the Canadian population: an age-period-cohort analysis

Abstract Background Using longitudinal panel data, the aim of this study was to examine the contribution of age, period, and cohort effects on changes in physical activity over time in a population-based sample of Canadians. We focused on three domains of physical activities: leisure time, commuting (i.e. walking and cycling), and daily activities (i.e. sedentary behavior). We also examined whether changes in sedentary behavior related to changes in participation in leisure time and commuting activities. Methods We used data from the Longitudinal National Population Health Survey (1994–2011): 10050 participants born between 1935 and 1984 grouped in five 10-years birth cohorts. We examined three outcomes: moderate-to-vigorous leisure time physical activity, active commuting, and sedentary behavior. We also included education, income, and body mass index as covariates. We used hierarchical age-period-cohort analysis to examine the contribution of age, period, and cohort effects to changes over time for each outcome. Results We found that recent cohorts were more likely to report sedentary behavior and greater participation in leisure time physical activities and active commuting. We also found a significant trend of increasing participation in active leisure time physical activity and active commuting among Canadians from 1994/95 to 2010/11 and, at the same time, an increase in sedentary behavior. The greater participation in leisure time physical activities and active commuting in each succeeding recent cohort was partially related to the secular trend of increasing participation in physical activities over time in the population. Furthermore, those with sedentary behavior were less likely to report participation in physical activities. Overall, obese individuals were less likely to be physically active and more likely to be sedentary, while the effect of socio-economic status varied by outcome. Conclusions The greater participation in physical activities (leisure time and commuting) in recent cohorts is encouraging and was substantially explained by period effects, which reflect broad social and environmental factors affecting the whole population. The large cohort effect of increasing sedentary behavior and the inverse relationship between sedentary behavior and physical activity is concerning, and identifies a target group for future interventions

Additional file 4: of Generational differences in patterns of physical activities over time in the Canadian population: an age-period-cohort analysis

Results from Hierarchical Age-Period-Cohort Models (with Age - Sedentary Behavior and Birth Cohort - Sedentary Behavior Interactions) for Active Leisure Time Physical Activity and Active Commuting. Canadian National Population Health Survey, 1994-2011. (DOCX 18 kb

Additional file 2: of Generational differences in patterns of physical activities over time in the Canadian population: an age-period-cohort analysis

Results from Logistic Two-level Growth Model (1) and Hierarchical Age-Period-Cohort Models (2 & 3) for Active Commuting. Canadian National Population Health Survey, 1994-2011. (DOCX 17 kb

The pathway to orthopaedic surgery: a population study of the role of access to primary care and availability of orthopaedic services in Ontario, Canada

Objective: To examine the impact of access to primary care physicians (PCPs), geographic availability of orthopaedic surgeons, socioeconomic status (SES), proportion of older population (≥65 years) and proportion of rural population on orthopaedic surgeon office visits and orthopaedic surgery. Design: Population multilevel study. Setting: Ontario, Canada. Participants: Ontario residents 18 years or older who had visits to orthopaedic surgeons or an orthopaedic surgery for musculoskeletal disorders in 2007/2008. Primary and secondary outcomes: Office visits to orthopaedic surgeons and orthopaedic surgery. Results: Access to PCPs and the index of geographic availability of orthopaedic surgeons, but not SES, were significantly associated with orthopaedic surgeon office visits. There was a significant interaction between access to PCPs and orthopaedic surgeon geographic availability for the rate of office visits, with access to PCPs being more important in areas of low geographic availability of orthopaedic surgeons. After controlling for office visits with orthopaedic surgeons, the index of geographic availability of orthopaedic surgeons was no longer significantly associated with orthopaedic surgery. Conclusions: The findings suggest that, particularly, in areas with low access to PCPs or with fewer available orthopaedic surgeons, residents are less likely to have orthopaedic surgeon office visits and in turn are less likely to receive surgery. Efforts to address adequate access to orthopaedic surgery should also include improving and facilitating access to PCPs for referral, particularly in geographic areas with low orthopaedic surgeon availability.Canadian Institutes of Health Research (CIHR

Magnitude of impact and healthcare use for musculoskeletal disorders in the paediaric: a population-based study

Abstract Background Although musculoskeletal disorders (MSD) are among the most prevalent chronic conditions, minimal attention has been paid to the paediatric population. The aim of this study is to describe the annual prevalence of healthcare contacts for MSD by children and youth age 0-19 years, including type of MSD, care delivery setting and the specialty of the physician consulted. Methods Analysis of data on all children with healthcare contacts for MSD in Ontario, Canada using data from universal health insurance databases on ambulatory physician and emergency department (ED) visits, same-day outpatient surgery, and in-patient admissions for the fiscal year 2006/07. The proportion of children and youth seeing different physician specialties was calculated for each physician and condition grouping. Census data for the 2006 Ontario population was used to calculate person visit rates. Results 122.1 per 1,000 children and youth made visits for MSD. The majority visited for injury and related conditions (63.2 per 1,000), followed by unspecified MSD complaints (33.0 per 1,000), arthritis and related conditions (27.7 per 1,000), bone and spinal conditions (14.2 per 1,000), and congenital anomalies (3 per 1,000). Injury was the most common reason for ED visits and in-patient admissions, and arthritis and related conditions for day-surgery. The majority of children presented to primary care physicians (74.4%), surgeons (22.3%), and paediatricians (10.1%). Paediatricians were more likely to see younger children and those with congenital anomalies or arthritis and related conditions. Conclusion One in eight children and youth make physician visits for MSD in a year, suggesting that the prevalence of MSD in children may have been previously underestimated. Although most children may have self-limiting conditions, it is unknown to what extent these may deter involvement in physical activity, or be indicators of serious and potentially life-threatening conditions. Given deficiencies in medical education, particularly of primary care physicians and paediatricians, it is important that training programs devote an appropriate amount of time to paediatric MSD

A sequential modeling approach for predicting clinical outcomes with repeated measures

The increased availability of healthcare data has made predictive modeling popular in a clinical setting. If an expected patient-specific outcome can be estimated prior to a medical intervention the healthcare costs can be reduced for both patient and provider. The nature of data used to train such predictive models is frequently longitudinal, as interventions with convalescence times or chronic conditions contain outcome measures at intermediate follow-up points. Here we outline a predictive modeling approach that takes advantage of the longitudinal structure of the data by sequentially predicting the outcomes at intermediate time points and including them as predictors in models for later time points. This is done for continuous and threshold-dichotomized outcomes. The proposed method improves predictive accuracy as it takes advantage of the correlation in follow-up measures to distribute the estimation of coefficient effects over several models, making it advantageous for smaller datasets. This formulation also allows for effective screening of first-order interaction effects. The improved performance is illustrated using a simulation study and an applied example of predicting outcomes following surgery. The proposed approach is shown to be consistent for prediction, effective in modeling interactions and robust to presence of noise variables.</p