Power JD, Perruccio AV, Desmeules M, Lagacé C, Badley EM. Ambulatory physician care for musculoskeletal disorders in Canada. J Rheumatol. 2006 Jan;33(1):133-9. [Pub Med ID 16395761]

Objective

To examine patterns of ambulatory physician visits for musculoskeletal disorders (MSD) in Canada.

Methods

Physician claims data from 7 provinces were analyzed for ambulatory visits made by adults age ≥15 years to primary care physicians and specialists (all medical specialists, rheumatologists, internists, all surgical specialists, orthopedic surgeons) for MSD (arthritis and related conditions, bone disorders, back disorders, ill defined symptoms) during fiscal year 1998-99. Person-visit rates and total and mean number of visits to all physicians for MSD were calculated by condition group. The percentages of patients with MSD seeing physicians of different specialties were also calculated. Provincial data were combined to calculate national estimates.

Results

Over 15.5 million physician visits were made for MSD during 1998-99. About 24% of Canadians made at least one physician visit for MSD: 16% for arthritis and related conditions, 2% for bone disorders, 7% for back disorders, and 6% for ill defined symptoms. Person-visit rates for MSD varied by province, were highest among older Canadians, and were greater for women than men. Primary care physicians were commonly seen, particularly for back disorders. Consultation with surgical and medical specialists was less common and varied by province and by condition.

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Conclusion

MSD place a significant burden on Canada's ambulatory healthcare system. As the population ages, there will be an escalating demand for care. Careful planning will be required to ensure that those affected have access to the care they require. A limitation in using administrative data to examine health service utilization is that MSD diagnostic codes require validation.

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List of Tables and Figures (in the publication)

Table 1. Diagnostic codes for musculoskeletal disorders.
Table 2. Visits to all physicians for musculoskeletal disorders.
Table 3. Person-visit rates to all physicians for musculoskeletal disorders among adults aged ≥ 15 years by Canadian province, 1998-99.
Figure 1. Person-visit rates to all physicians for musculoskeletal disorders among adults age ≥ 15 years, by sex and age group, in participating Canadian provinces, 1998-99.
Table 4. Distribution of type of physician seen by adults aged ≥ 15 years for musculoskeletal disorders, participating Canadian provinces, 1998-99.
Table 5. Percentage of patients aged › 15 years who saw a medical specialist or a surgical specialist at least once for musculoskeletal disorders, by Canadian province, 1998-99.

Selected Tables from the Publication (with interpretation)

Table 2: Visits to all physicians for musculoskeletal disorders by adults aged ≥ 15 years, Canada, 1998-99.

Condition	Persons Visiting per 1,000 Populationii	Sex Ratio (women:men)	Estimated total No. of Visitsiii	Average No. of Visits per Person
Arthritis and related conditions	162.7	1.3:1	8,800,000	2.3
Bone disorders	14.9	3.9:1	600,000	1.7
Back disorders	66.3	1.2:1	3,540,000	2.2
Ill-defined symptoms	60.3	1.3:1	2,630,000	1.8
All musculoskeletal disorders	242.8	1.3:1	15,570,000	2.7

In Table 2, we see that roughly one-quarter of Canadians made at least one visit to a physician for a MSD during 1998-99. Just over 16% of the population made a visit for an arthritis or arthritis-related condition. On average, individuals made 2.7 visits for MSD, for an estimated total of over 15.5 million visits. Total number of visits for arthritis and related conditions, back disorders, and bone disorders was estimated at 8.8 million, 3.5 million, and 600,000 respectively. An additional 2.6 million visits were coded as being due to ill-defined musculoskeletal symptoms rather than specific conditions. More women than men made visits for each of the condition groups studied, with the biggest sex difference occurring for bone disorders.

Table 4: Distribution of type of physician seen by adults aged ≥ 15 years for musculoskeletal disorders, participating Canadian provinces, 1998-1999.

Condition	Type of Physician,iv %
	Primary Care	All Specialists	Medical Specialists			Surgical Specialists
			All	Rheumatologists	Internists	All	Orthopaedic Surgeons
Arthritis and related conditions	82.0	30.3	13.7	5.5	4.8	18.5	15.1
Bone disorders	65.6	37.3	23.5	4.9	8.8	14.4	12.8
Back disorders	89.4	18.3	9.1	1.5	1.9	10.6	6.9
Ill-defined symptoms	91.1	11.7	7.9	1.0	2.2	4.0	2.8
All musculoskeletal disorders	88.3	26.6	13.2	4.2	4.4	15.7	12.4

Overall, 88% of individuals who visited any type of physician for MSD saw a primary care physician at least once and 27% saw a specialist. Orthopedic surgeons were the most common type of specialist consulted, followed by internists. The proportion of individuals seen by primary care physicians varied by condition, being highest for ill- defined symptoms and back disorders and lowest for bone disorders. There was also substantial variation in proportions seeing different kinds of specialists by condition.

Supplementary Tables (with interpretation)

No supplementary information is available for this paper.

Buchbinder R, Goel V, Bombardier C. Lack of concordance between the ICD-9 classification of soft tissue disorders of the neck and upper limb and chart review diagnosis: one steel mill’s experience. Am J Ind Med 1996; 29: 171-82.
Person visit rates for arthritis and related conditions, bone disorders, back disorders and ill-defined symptoms do not add to the rate for all musculoskeletal disorders, as an individual may see a physician for more than one of these conditions in a year.
A rate was calculated using data from the 7 participating provinces, and visits for the 3 non-participating provinces were estimated by applying this rate to their respective 1998 provincial populations. All other data in the table are from the 7 participating provinces only.
Row percentages do not sum to 100% as an individual can visit more than one type of physician in a year.