Patterns and determinants of health care utilization among people with Parkinson's disease: A population-based analysis in Ontario, Canada

PLoS One. 2024 Jun 21;19(6):e0305062. doi: 10.1371/journal.pone.0305062. eCollection 2024.

Abstract

In Ontario, despite the increasing prevalence of Parkinson's disease (PD), barriers to access-to-care for people with Parkinson's disease (PwP) and their caregivers are not well understood. The objective of this study is to examine spatial patterns of health care utilization among PwP and identify factors associated with PD-related health care utilization of individuals in Ontario. We employed a retrospective, population-based study design involving administrative health data to identify PwP as of March 31, 2018 (N = 35,482) using a previously validated case definition. An enhanced 2-step floating catchment area method was used to measure spatial accessibility to PD care and a descriptive spatial analysis was conducted to describe health service utilization by geographic area and specialty type. Negative binomial regression models were then conducted to identify associated geographic, socioeconomic, comorbidity and demographic factors. There was marked spatial variability in PD-related service utilization, with neurology and all provider visits being significantly higher in urban areas (CMF>1.20; p<0.05) and family physician visits being significantly higher (CMF >1.20; p<0.05) in more rural areas and remote areas. More frequent visits to family physicians were associated with living in rural areas, while less frequent visitation was associated with living in areas of low spatial accessibility with high ethnic concentration. Visits to neurologists were positively associated with living in areas of high spatial accessibility and with high ethnic concentration. Visits to all providers were also positively associated with areas of high spatial accessibility. For all outcomes, less frequent visits were found in women, older people, and those living in more deprived areas as years living with PD increased. This study demonstrates the importance of geographic, socioeconomic and individual factors in determining PwP's likelihood of accessing care and type of care provided. Our results can be expected to inform the development of policies and patient care models aimed at improving accessibility among diverse populations of PwP.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Health Services Accessibility / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Ontario / epidemiology
  • Parkinson Disease* / epidemiology
  • Parkinson Disease* / therapy
  • Patient Acceptance of Health Care* / statistics & numerical data
  • Retrospective Studies
  • Rural Population / statistics & numerical data
  • Socioeconomic Factors

Grants and funding

This study was supported by ICES, which is funded in part by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The study was completed at the ICES Western site, where core funding is provided by the Academic Medical Organization of Southwestern Ontario, the Schulich School of Medicine and Dentistry, Western University, and the Lawson Health Research Institute. The analyses, conclusions, opinions, and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred. The author T.M. has received funding for this work from the EU Joint Programme - Neurodegenerative Disease Research (JPND), an initiative of the Canadian Institute for Health Research (CIHR). This funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.