Access to Care

Access to care for patients with lupus affected by several local factors

Patients with systemic lupus erythematosus (lupus), an autoimmune disease, typically suffer from fatigue, skin rashes, and joint pain. If the disease is more serious, they have problems with their kidneys, heart, lungs, blood, or nervous system. Access to care for this complex condition, ideally managed by rheumatologists, may be affected by an individual's socioeconomic status, neighborhood poverty, and characteristics of the local health care system, concludes a new study. Chris Tonner, M.P.H., and colleagues at the University of California, San Francisco, examined the impact of individual, neighborhood, and local care system factors (e.g., number of specialists per capita) on the number of physician visits for lupus reported by 755 adults who participated in the Lupus Outcomes Study from 2004 to 2007.

The strongest factors influencing care access were type of health insurance, physician specialty, and area-specific poverty concentration. Persons receiving their care through a health maintenance organization (HMO) had 10 percent fewer physician visits than those seen in non-HMO settings. An even stronger effect occurred for the specialty of a patient's main physician. Persons with lupus seen by generalists reported 7.9 mean visits for the condition in the year prior to interview, compared with 11.9 mean visits for those seen by rheumatologists. This represents a mean difference of 50 percent in relative terms, even after taking into account individual demographics and health status.

Where one lived also affected the amount of care received for lupus. Persons living in areas of concentrated poverty reported 16 percent fewer physician visits. This study confirms that the differences in the most basic measure of access, the number of physician visits for lupus over a year, are substantial, and in part due to the specific nature of the community in which a person resides. This study was supported by the Agency for Healthcare Research and Quality (HS13893).

See "Role of community and individual characteristics in physician visits for persons with systemic lupus erythematosus," by Mr. Tonner, Laura Trupin, M.P.H., Jinoos Yazdany, M.D., M.P.H., and others in the June 2010 Arthritis Care and Research 62(6), pp. 888-895.

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