Arthritis and Related Conditions in Ontario - ICES Research Atlas

170 Pages·2013·9.86 MB·English

Arthritis and
related conditions
in Ontario
ICES Research Atlas
September 2004

Arthritis and
Related Conditions
in Ontario
ICES Research Atlas
2nd Edition
September 2004
Authors
EM Badley, DPhil NM Kasman, MSc
E Boyle, MSc H Kreder, MD, MPH, FRCS(C)
L Corrigan, BHScPT, MSc C MacKay, BScPT, MHSc
D DeBoer, MMath N Mahomed, MD, ScD
RH Glazier, MD, MPH MM Mamdani, PharmD, MA, MPH
J Guan, MSc AV Perruccio, MHSc
G Hawker, MSc, MD, FRCPC JD Power, MHSc
SB Jaglal, PhD D Shipton, PhD
J Williams, PhD
Institute for Clinical Evaluative Sciences
Toronto
Arthritis and Related
Conditions in Ontario
Published by the Institute for Clinical Evaluative Sciences (ICES)
©2004
All rights reserved. No part of this publication may be reproduced, stored
in a retrieval system or transmitted in any form or by any means, electronic,
mechanical, photocopying, recording or otherwise, without the proper written
permission of the publisher.
Canadian cataloguing in publication data
Arthritis and Related Conditions in Ontario: ICES Research Atlas.
Includes bibliographical references.
ISBN 0-9730491-8-9
i. Badley, Elizabeth M. 1946
ii. Glazier, Richard H. 1956
How to cite the publication:
The production of Arthritis and Related Conditions in Ontario: ICES Research Atlas was
a collaborative venture. Accordingly, to give credit to individual authors, please cite
individual chapters using chapter authors and title, in addition to editors and book
title. For example, for Chapter 2: Perruccio AV, Badley EM, Guan J. Burden of disease.
In: Badley EM, Glazier RH, editors. Arthritis and related conditions in Ontario: ICES
research atlas. 2nded. Toronto: Institute for Clinical Evaluative Sciences; 2004.
Institute for Clinical Evaluative Sciences (ICES)
G1 06, 2075 Bayview Avenue
Toronto, ON M4N 3M5
Telephone: [phone]
www.ices.on.ca
Arthritis and Related ICES Research Atlas
Conditions in Ontario
Authors’affiliations…page i
Acknowledgments…page ii
About the organizations involved…page iii
Exhibits & appendices directory…page v
Map guide—Population geography and mapping boundaries …page xi
Overview…page xv
Key findings & policy options…page xvii
Chapter 1: Emerging Issues…page 1
EM Badley
Chapter 2: Burden of Disease…page 15
AV Perruccio, EM Badley and J Guan
Chapter 3: Availability of Services…page 41
D Shipton and EM Badley
Chapter 4: Primary and Specialist Care…page 67
JD Power, RH Glazier, E Boyle and EM Badley
Chapter 5: Use of Medication…page 87
NM Kasman, JD Power, MM Mamdani and EM Badley
Chapter 6: Surgical Services…page 105
J Williams, D Shipton, EM Badley, G Hawker, H Kreder, D DeBoer,J Guan and N Mahomed
Chapter 7: Rehabilitation for Total Joint Replacement…page 133
SB Jaglal, C MacKay and L Corrigan
s
t
n
e
t
n
o
C

Arthritis and Related ICES Research Atlas
Conditions in Ontario
EM Badley, DPhil NM Kasman, MSc
Director Research Associate
Arthritis Community Research and Evaluation Unit Arthritis Community Research and Evaluation Unit
Professor
Departments of Public Health Sciences, Medicine and H Kreder, MD, MPH, FRCS(C)
Rehabilitation Sciences, University of Toronto Adjunct Scientist
Institute for Clinical Evaluative Sciences
Senior Adjunct Scientist
Institute for Clinical Evaluative Sciences Associate Professor
Departments of Surgery, Health Policy, Management
and Evaluation, and Clinical Epidemiology,
E Boyle, MSc
University of Toronto
Doctoral Student
Arthritis Community Research and Evaluation Unit Director
Orthopaedic Research, Department of Orthopaedic
Surgery, Sunnybrook and Women’s College Health
L Corrigan, BHScPT, MSc
Sciences Centre
Physiotherapy Practice Leader
Musculoskeletal Health and Arthritis,
Toronto Western Hospital, University Health Network C MacKay, BScPT, MHSc
s
Research Associate
Arthritis Community Research and Evaluation Unit
D DeBoer, MMath
n
Director
Programming and Biostatistics, N Mahomed, MD, ScD
Institute for Clinical Evaluative Sciences Adjunct Scientist
o
Institute for Clinical Evaluative Sciences
RH Glazier, MD, MPH Investigator
Adjunct Scientist Arthritis Community Research and Evaluation Unit
i
Institute for Clinical Evaluative Sciences
Assistant Professor
t
Investigator Orthopaedic Surgery, University of Toronto
Arthritis Community Research and Evaluation Unit
a Orthopaedic Surgeon and Medical Director of the
Associate Professor Musculoskeletal Health and Arthritis Program
Departments of Family & Community Medicine and Toronto Western Hospital, University Health Network
i Public Health Sciences, University of Toronto
l Scientist MM Mamdani, PharmD, MA, MPH
Inner City Health Research Unit, St. Michael’s Hospital Scientist
i
Institute for Clinical Evaluative Sciences
f
J Guan, MSc Associate Professor
f Biostatistician Department of Health Policy, Management and
Institute for Clinical Evaluative Sciences Evaluation, Faculty of Medicine and Faculty of
Pharmacy, University of Toronto
a
G Hawker, MD, MSc, MD, FRCPC
Senior Adjunct Scientist AV Perruccio, MHSc

Institute for Clinical Evaluative Sciences Research Associate
’ Arthritis Community Research and Evaluation Unit
Investigator
s Arthritis Community Research and Evaluation Unit
JD Power, MHSc
Associate Professor
Research Associate
r Departments of Medicine, and Health Policy,
Arthritis Community Research and Evaluation Unit
Management and Evaluation, University of Toronto
o
Staff Rheumatologist and Director, FM Hill Chair
D Shipton, PhD
in Academic Women’s Medicine
Postdoctoral Fellow
Osteoporosis Research Program, Sunnybrook and
h Women’s College Health Sciences Centre, WC Campus Arthritis Community Research and Evaluation Unit
SB Jaglal, PhD J Williams, PhD
t Scientist Emeritus
Adjunct Scientist
Institute for Clinical Evaluative Sciences
Institute for Clinical Evaluative Sciences
u
Associate Professor
Department of Physical Therapy, University of Toronto
A
i
Arthritis and Related
Conditions in Ontario
The authors and editors sought to produce work that is Linda Li
relevant to a wide range of stakeholders, from research Physiotherapist, Research Fellow
to policy, public health to clinical nursing, rehabilitation Toronto General Research Institute
and medicine. Accordingly, a number of leaders in Donald E. McGregor
these fields reviewed the atlas from the perspective of Consumer (Vice-Chair Board of Directors, The Arthritis
their professional expertise. We thank them for their Society—Ontario Division)
contribution to the success of this project. We
Dianne Mosher
apologize in advance for any unintentional omissions. Rheumatologist
Queen Elizabeth II Health Science Centre, Halifax, Nova Scotia
Critical Review Peter Norton
Professor and Head
Patricia Beckett
Department of Family Medicine, University of Calgary
Physiotherapist
The Arthritis Society Janet Pope
Rheumatologist
Claire Bombardier
St. Joseph’s Health Centre
Professor of Medicine,
Rheumatology Division Director Mark Sack
University of Toronto Consumer (Vice-President, Institutional Investments)
Robert Bourne Jo-Anne Sobie
Orthopaedic Surgeon Executive Director
s
London Health Sciences Centre The Arthritis Society—Ontario Division
t Ruth Carlisle Margaret Vas
Policy Analyst Physiotherapist
n Ministry of Health and Long-Term Care The Arthritis Society
Pierre Côté James Waddell
Scientist Orthopaedic Surgeon
e
Institute for Work and Health St. Michael’s Hospital
Sharon Cummings Kathryn Whaley
m Occupational Therapist Consumer
The Arthritis Society
James Wright
Pat D’Hondt Orthopaedic Surgeon
Physiotherapist The Hospital for Sick Children
g The Arthritis Society
Susan Jaglal Institute for Clinical Evaluative Sciences
Adjunct Scientist
d Paula McColgan
Institute for Clinical Evaluative Sciences
Director
Policy and External Relations
Meera Jain
e Senior Policy Analyst Carolynne Varney
Ministry of Health and Long-Term Care Editor
Laura Benben
l Marjorie Keast
Design
Manager
w
Population Health Strategies Unit Continental Press
Ministry of Health and Long-Term Care Printing
Deborah Kennedy
Physiotherapist, Research Associate (Arthroplasty Program) ACREU Scientific Coordinator
o
Orthopaedic and Arthritis Institute Crystal MacKay
Mary Kim
ACREU Internal Review
n Consumer (Patient Partners in Arthritis and Canadian
Arthritis Patient Alliance) Nada Abdel-Malek
Rachel Devitt
Anne Lyddiatt
k Olga Manuk
Consumer (National Trainer for Patient Partners in Arthritis)
Cristina Mattison
Michel Landry Leslie Soever
c Physiotherapist, Research Fellow Jeanette Tyas
Medicare to Home and Community Research Unit Annette Wilkins
A University of Toronto Rose Wong
Jody Lewtas
ACREU Administrative Support
Rheumatologist
Markham Stouffville Health Centre Olga Manuk
ii
ICES Research Atlas
About the organizations involved in the study
Institute for Clinical Evaluative educational backgrounds ensures a The Arthritis Society
Sciences (ICES) multi-disciplinary approach to issues The mission of The Arthritis Society is
Ontario’s resource for informed management and creates a real-world to search for the underlying causes and
health care decision-making mosaic of perspectives that is vital to subsequent cures for arthritis, and to
shaping Ontario’s future health care. promote the best possible care and
ICES is an independent, non-profit treatment for people with arthritis. The
ICES collaborates with experts from a
organization that conducts research on a Arthritis Society is Canada’s not-for-profit
diverse network of institutions,
broad range of topical issues to enhance organization devoted solely to funding
government agencies, professional
the effectiveness of health care for and promoting arthritis research,
organizations and patient groups to
Ontarians. Internationally recognized for programs and patient care. It has a
ensure research and policy relevance.
its innovative use of population-based national administrative office in Toronto,
health information, ICES knowledge division offices in each province and
provides evidence to support health Arthritis Community Research nearly 1,000 community branches
policy development and changes to the and Evaluation Unit (ACREU) throughout Canada.
organization and delivery of health care
services. The Arthritis Society provides hope
The Arthritis Community Research and
through education, community support
Evaluation Unit (ACREU) was founded in
Unbiased ICES evidence provides fact-based and research-based solutions to the over
1991 as an interdisciplinary research unit.
measures of health system performance; 4 million Canadians living with arthritis,
Our mission is to explore the impact of
a clearer understanding of the shifting for a better life—today and tomorrow.
arthritis on individuals, their families,
health care needs of Ontarians; and a The Society is able to provide this due to
communities, and on the population at
stimulus for discussion of practical the widespread support it receives from
large, in order to further the development
solutions to optimize scarce resources. the tens of thousands of volunteers and
of targeted policies and effective
donors across the country.
interventions. ACREU is the primary
Key to ICES’ research is our ability to link
source for reliable data on arthritis in
anonymous population-based health An 21-member national board is
Canada. Research includes arthritis and
information on an individual patient responsible for managing and controlling
employment, primary care management,
basis, using unique encrypted identifiers the activities of The Society. The voluntary
access to specialists, joint replacement
that ensure privacy and confidentiality. board includes representatives from each
surgery and rehabilitation service delivery.
This allows scientists to obtain a more division, as well as other members
comprehensive view of specific health recruited from across Canada. National
ACREU investigators were major
care issues than would otherwise be staff provide administrative support for
contributors to the first-ever, federally
possible. Linked databases reflecting the board and facilitate cross-country
funded national study, Arthritis in
12 million of 30 million Canadians allow initiatives such as research and corporate
Canada (2003) as well as the first edition
researchers to follow patient populations partnerships. Each division operates
of the ICES research atlas, Patterns of
through diagnosis and treatment, and to within this structure, navigating with
Health Care in Ontario: Arthritis and
evaluate outcomes. local operating procedures established
Related Conditions(1998).
by their respective board of directors.
ICES brings together the best and the Rehabilitation was one of the original Divisions are responsible primarily for
brightest talent under one roof. Many of research themes at ACREU and it continues fundraising, promoting and/or providing
our faculty are not only internationally to be an important research focus. Among patient or client care, delivering
recognized leaders in their fields, but are the recent achievements in ACREU- education programs and providing
also practising clinicians who understand associated rehabilitation research are the advocacy at the local level.
the grassroots of health care delivery,
Hospital Report 2003: Rehabilitation,and
making ICES knowledge clinically-
the development of the Client Centred
focused and useful in changing practice.
Rehabilitation Questionnaire (CCRQ),
Other team members have statistical
which is being used throughout Ontario
training, epidemiological backgrounds,
for clients discharged from Inpatient
project management or communications
Rehabilitation Services.
expertise. The variety of skill sets and
iii
iv