Background/Purpose: Ontario, Canada’s most populous province, has publicly funded, universal health insurance covering medically necessary hospital and physician services with no copayments. The purpose of this study was to quantify the burden of arthritis and related conditions (A&R) on the Ontario health care system, according to service type ( ambulatory vs. inpatient care) physician specialty (primary care, rheumatology, orthopedics), and hospital setting (emergency department (ED), day surgery, inpatient care).

Methods: Administrative health data were analyzed for fiscal 2013/14 for Ontarians aged 18+ years (N=10,841,302). Data sources included: the Ontario Health Insurance Plan (OHIP) Claims History Database, which captures data on in- and out-patient physician services; the Canadian Institute for Health Information (CIHI) Discharge Abstract Database, which records diagnoses and procedures associated with all inpatient hospitalizations; and the CIHI National Ambulatory Care Reporting System, which captures data on all ED and day surgery encounters. Services associated with A&R were identified using the International Classification of Diseases (ICD) diagnosis code identified on each physician service claim as the “main reason” for each outpatient physician visit and the “most responsible” ICD diagnosis code recorded on each hospitalization, ED visit and day surgery record. Patient visit rates and numbers of patients and visits were tabulated according to care setting, patient age and sex, and physician specialty for the grouping of all A&R, as well as for specific diagnoses, such as osteoarthritis (OA) and rheumatoid arthritis (RA).

Results: Overall, 1.3 million adult Ontarians (11.9%) made 2.7 million outpatient physician visits for A&R in 2013/14, with 62% of these visits occurring in primary care. Patient visit rates for A&R increased with age and were higher in women than men; women accounted for 60% of all A&R visits. Approximately 5% of adult Ontarians made an outpatient physician visit specifically for OA, with about 1% making at least 1 visit for RA. 63% of outpatient visits for OA, and 35% for RA, were in primary care. Just over 25% of adult Ontarians who saw a physician for OA consulted an orthopaedic surgeon at least once and 58% who made a visit for RA consulted a rheumatologist at least once. Just over 1% of adult Ontarians made an ED visit for which the most responsible diagnosis was A&R, for a total of 142,000 visits. Rates of hospitalization and day surgery for A&R were 410 and 190 per 100,000 population, respectively. The highest rate of inpatient hospitalization was associated with OA, at 340 per 100,000, which accounted for 82% of all A&R-related hospital admissions.

Conclusion: A&R place a significant burden on the health care system, particularly in primary care. As the population ages, it will be essential that health system planning takes into account the large demand for arthritis care, both in terms of health human resources planning and implementation of clinically and cost-effective models of care.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/ambulatory-and-hospital-care-for-arthritis-and-related-conditions-in-ontario-canada/